Quality Improvement Lead

Responsibilities:

Lead Behavioral Health Performance Improvement activities, track performance trends and incidents, conduct Root Cause Analysis, and ensure high quality and culturally responsive care.

Lead continuous survey readiness activities (mock surveys, tracer methodology) for external audits,  interpret and operationalize regulatory requirements into clinical workflows and policies, ensure contracted services meet accreditation standards, and ensure ongoing compliance with all applicable regulations and standards (e.g., The Joint Commission Behavioral Health standards). 

Conduct chart audits for timely assessments, treatment plans, medical necessity, and discharge planning, identify risks and implement corrective actions, and partner with supervisors on provider documentation issues

Track key metrics, support Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) processes for licensed providers, and develop dashboards and reports for leadership review.

Educate staff on documentation, risk assessment, incident reporting, and quality improvement processes, support competency validation, and address performance gaps with leadership.

Coordinate Behavioral Health Quality/Performance Improvement Committee,  partner with Risk Management/Compliance on investigations and mitigation strategies, and support Performance Improvement plan development and annual evaluation.

Analyze, develop and monitor clinical QI activities to ensure compliance with customer guarantees and lead clinical quality audits with benefits and customer teams

Investigate and resolve behavioral health quality of care complaints and grievances

Other duties as assigned

Competencies:

Knowledge 

Clinical Knowledge: A strong understanding of mental health conditions, empirically supported treatment options, and patient progress evaluation.

Knowledge of Cultural Factors: Ability to recognize cultural, linguistic, and socioeconomic differences in client populations and sharing this information with the interprofessional team to ensure accurate communication with diverse clients,  families and needs.

Virtual Platforms and Remote Services: Ability to interact through secure virtual platforms. Ability to maintain the integrity, privacy, and security of private and confidential data in a virtual health care setting. 

Detail Oriented/Documentation:  Proficiency with utilizing Electronic Health Record(s), and other platforms as needed, and attention to ensuring all verbal and written communication is accurate, private, and secure. Ensure accuracy and timeliness in submitting documentation within the electronic health record. 

Practice Based Learning & Improvement 

Utilize Scientific Evidence in Practice: Stay up to date on all required and applicable, role, program, and company training.

Adaptability to Technologies: Flexibility in learning new technologies and staying up-to-date on advances in virtual healthcare delivery. 

Self Assessment and Reflection: Ability to think critically and adjust processes in real-time when needed, consulting with the interprofessional team if modifications are required based on client needs.

Interpersonal and Communication 

Collaboration and Interprofessional Communication: Strong ability to work collaboratively with supervisors, team leads, and other clinical staff, contributing to the development and execution of communication, services, and plans. Ability to effectively coordinate with interprofessional teams to communicate updates and adapt communication as needed.

System Based Practice 

Awareness of System: Understands systems policies, protocols, and processes, and demonstrates compliance, as evidenced by ability to verbalize, or explain policies, protocols, and processes and knowledge how systems support access and care.

Promoting Safety and Quality: Works effectively within a team to enhance patient safety and improve the quality of care, including identifying and support opportunities to improve care across different programs. 

Professionalism 

Ethical and Confidential Practice: Adherence to legal and ethical standards in health care delivery, maintaining patient confidentiality, and ensuring HIPAA-compliant documentation and communication.

Time Management, Organization, and Responsivity: Ability to balance multiple tasks, including managing schedules, and collaborating with the quality team, while maintaining accurate records and staying organized. Ability to manage a task list, and set priorities effectively. Demonstrated ability to manage time effectively while ensuring timely communication and follow-up within and outside the clinical team, the client/family, and their community ensuring continuity of care.

Qualifications:

Master’s or doctoral degree from a behavioral health clinical track (e.g., LCSW, LMHC, LPC, MSW, LMFT, LPC, Ph.D, Psy.D.) 

Current unrestricted license to practice within the United States

3+ years in behavioral health, quality improvement, or compliance, with experience in chart audits, incident review, and regulatory surveys.

Strong understanding of Behavioral Health clinical workflows and documentation requirements, coupled with a high attention to detail and regulatory compliance.

Knowledge of performance improvement methodologies (PDSA, Lean, Six Sigma).

Data analysis and interpretation skills.

Ability to collaborate with multidisciplinary teams and influence practice change.