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QA Program Director
Oakland, CA 94609 US
Job Description
To continue in its pursuit of quality care, we are looking for a Director of Quality Assurance to join our executive leadership team. Currently, the Director of Programs is responsible for QA and UR across all sites. The Director of QA would support the Director of Programs in assuring organizational compliance with BHI, governmental, and external agencies’ standards, policies, and procedures for quality and accurate documentation. The Director of QA would be responsible for managing the utilization review process for Medicare and Medi-Cal services provided in case management, residential treatment, and day rehabilitation services, performing charts reviews and internal audits, authorizing documentation, providing training to and interfaces with paraprofessional and professional staff members, and external review agencies to ensure clients receive the best and most appropriate care.
Essential Functions of Position
The Director of Quality Assurance will…
·        Be responsible for planning, organizing, developing, evaluating, and when necessary, revising BHI Utilization Review processes.
·        Coordinate with the Director of Administration and administrative staff to ensure that services delivered are the services billed.
·        Work with county, state, and federal representatives to ensure BHI complies with Medi-Cal utilization review regulations.
·        Provide training and information on Medicare and Medi-Cal Utilization Review requirements to clinical, supervisory, and management staff.
·        Support Program Management/Directors with the CQRT process regularly and chairs the CQRT monthly meeting.
·        Track and reviews client’s Medicare/Medi-Cal documentation to ensure compliance with state and federal regulations relating to medical necessity and accuracy of all documentation.
·        Redesign and conduct regular chart and client service audits.
·        Establish and maintain positive, collaborative relationships with program staff.Â
·        Participate with staff in utilization and quality improvement meetings and projects.
·        Compile, track, and review denied services; represents BHI in appeal of any adverse decisions.
·        Coordinate the Peer Review process in collaboration with Senior Management.
·        Provide retrospective reviews of Critical Incidents and Sentinel Events.
·        Develop outcome reports and present data for distribution.
·        Perform other duties as assigned.
Compensation and Benefits Summary
·        Compensation: Negotiable, depending on experience
·        PTO: 23 days accrued during the first year
·        Holidays: 12 paid holidays annually
·        CME Allowance: 5-days PTO and $2,000 allowance
·        Health Plan: Medical- Kaiser Bronze HDHP/HMO
·        Dental Plan: Delta Dental - DentalPremier coverage including adult orthodontia
·        Vision Plan: VSP - Signature Plan
·        Flexible Spending Account (FSA) - Sterling
·        Chiropractic and Acupuncture- Landmark
·        Retirement: Mutual of America
·        Life Insurance and Accidental Death and Dismemberment (AD&D) Insurance: Lincoln Life Insurance Company
·        Long Term Disability- Reliance
·        Malpractice Insurance covered by the Federal Tort Claims Act at no cost to you
·        Other Unique Benefits: Monthly potlucks, fresh fruit/healthy snacks delivery for staff, monthly staff recognition & event celebrations
Application and Interview Process
If interested in applying for this opportunity, please send an email to Isaiah Ritchie with your updated resume along with a few time blocks where you will be available for a 15–20-minute exploratory conversation. You can also call Isaiah directly at 503-379-1526. After our conversation, if you have a continued interest in Bonita House, we can schedule a 1-hour Zoom interview between you and the Director of Human Resources thereafter.
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Meet Your Recruiter
Wayne Holt
Director Behavioral Health
Wayne was born and raised in the Portland, Oregon area. After graduating high school, Wayne traveled abroad while serving four years as an active-duty Marine in the aviation field. After departing the military, Wayne started his education, career and family endeavors. The result: a graduate degree trained, recruiting professional, and family man— dedicated to his family and career.
Wayne’s passion for serving the community health population stemmed from a career introduction into the healthcare field, personal ethics and beliefs. When Wayne is not working, he enjoys spending quality time with his family, reading, and cooking.
