Quality Improvement - Clinical Quality Improvement Specialist

Join Home of the Innocents (HOTI), a non-profit dedicated to supporting children and families in our community. Our mission is to enrich lives with hope, health, and happiness. As one of only two certified Sanctuary Organizations in Kentucky, we prioritize safety and recovery through trauma-informed practices. Our leadership is committed to developing a diverse, inclusive, and values-led workforce.  

If you're passionate about making a difference for children, families, and our community, we invite you to apply! 

Position: Clinical Quality Improvement Specialist

The primary purpose of the Quality & Compliance Specialist position is to support the facilitation of quality management and performance improvement processes by serving as a data analysis, billing auditor, denial management, accounts receivable, subject matter expert (SME) for all Behavioral Health Services, and Long Term care Kosair for Kids Complex Care Center (KCC), in order to ensure the highest quality of care for residents, clients, service recipients, patients, and organizational adherence to best practices and regulatory requirements.

The position will assist in reviewing, maintaining, and upholding all policies, procedures, and regulatory guidance. This position will serve as a resource, providing guidance, consultation, and interpretation on standards/best practices, to assist in creating a trauma informed, therapeutic environment.

Duties/Responsibilities:

• Upholding QICC efforts that effectively communicate and support the organization’s vision, mission, values, Sanctuary commitments, and Diversity, Equity and Inclusion initiatives.
• Models the organization’s core values of compassion, wellness, excellence, and empowerment to all internal and external contacts.
• Models Sanctuary commitments of nonviolence, emotional intelligence, social learning, democracy, open communication, social responsibility, and growth and change.
• Responsible to monitor through evaluating the quality, necessity, and effectiveness of services provided, and ensuring compliance with regulatory, billing, and/or contractual documentation requirements.
• Responsible for data collection and analysis related to quality monitoring activities, preparation of summary reports, and presentation of findings to applicable committees (i.e., Quality Improvement Committee, Corporate Compliance Committee, Service Recipient Quality Advisory Council, Risk Management Committee, etc.).
• Provides Ethical Boundaries training. QI/CC training, and Compliance training.
• Provides assistance with quality-of-care reviews/investigations, including preparation of investigative summaries to be reported to the Corporate Compliance Committee.
• Participates in activities to support accreditation readiness, assists with compilation of required evidence, and participates in the site survey process.
• Participates in activities/projects related to data collection for the organization, data analysis, identification of opportunities for improvement, preparation of reports and summaries, and presentation of related findings.
• Assists with the development, revision, and implementation of written policies and procedures necessary for successful implementation of the QI/CC Department.
• Participates in activities, as assigned, to ensure compliance with organizational policy, procedures, regulations, and best practices, including (but not limited to) periodic review of program and/or client records and assistance with evaluation, tracking, or investigation related to Quality of Care (QOC) concerns and/or corporate compliance complaints/issues.
• Responsible for activities related to the development, coordination, facilitation, and tracking of training related to QI, Compliance, and Accreditation for the organization, as assigned by the CQCO.
• Performs other duties as assigned by the Chief Quality & Compliance Officer (CQCO).

Required Skills/Abilities:

• Excellent verbal and written communication skills. 
• Excellent interpersonal, counseling, negotiation, and conflict resolution skills.
• Excellent organizational skills and attention to detail.
• Excellent facilitation and presentation skills.
• Strong analytical and problem-solving skills.
• Policy & Procedure support and communication.
• Knowledge and experience in state and federal information privacy laws, including but not limited to HIPAA.
• Ability to maintain objectivity in decision making, maintain strict confidentiality related to client/patient care and/or other sensitive matters, and work independently in an oversight capacity is required.
• Intermediate experience with technical programs, including Microsoft Excel, Word, PowerPoint, SPSS, and Outlook is required.

Education and Experience:

• Master’s degree in human services or healthcare related field is required.
• Professional licensure (LCSW, LMFT, LPCC, etc.) in the state of Kentucky is required.
• A minimum of three years providing clinical behavioral health services is required.
• Experience working directly with children and/or families in a behavioral health, mental health, other healthcare delivery, or educational setting is required.
• A minimum of two years providing clinical training/education related to medical necessity and/or clinical best practices is strongly preferred.
• A minimum of two years of experience performing duties related to quality improvement, patient safety/risk management, compliance, audits, medical record review, or accreditation is strongly preferred.
• Professional certification as a Certified Professional in Healthcare Quality (CPHQ) is preferred.
• Professional certification as a Certified in Healthcare Compliance (CHC) is preferred.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 20 pounds at times.
• Works in office areas, moves intermittently throughout the facility, and is subject to frequent interruptions.
• Work hours are flexible and may extend into evenings and weekends if necessary.
• Occasional travel may be required for training, conferences, or other professional development opportunities.
• May be necessary to assist in the evacuation of residents during emergency situations.
• May be required to sit or stand for extended periods of time.