Overview
The Quality Assurance Associate, under the direction of the Chief Compliance & Quality Officer and working in cooperation with the Lead Quality Assurance Associate, utilizes a combination of excellent customer service, administrative, and analytical skills to ensure the agency can deliver high-quality client care services. This role is focused on investigating, managing, and resolving incidents that affect quality care.
Essential Duties And Responsibilities
- Conducts investigations for both the Personal Care and Developmental Care service lines. These investigations involve obtaining witness statements and interviews, securing evidence, retrieving information from electronic surveillance, reviewing staff schedules, compiling information from the agency’s EHR system, and developing a chronological summary of factual findings from occurrence to closure. Depending on the incident, investigations may require traveling into the field to client homes to conduct investigations. (Coverage area: Philadelphia, Bucks, Montgomery, Delaware and Chester counties)
- Completes and maintains Certified Investigator credential status from the PA Office of Development Program (ODP). Conducts investigations in accordance with ODP regulations.
- Complies with required incident management reporting timeframes, ensuring investigations are filed, finalized or extended according to the timelines set forth by regulatory and agency standards to maintain speed, objectivity, and thoroughness.
- Attends to all reportable data entry in the PA Enterprise Incident Management (EIM) System and documents all case activity for internal records.
- Investigates potential fraud events and complaints involving client or caregiver safety. Makes recommendations for resolution, documents actions taken, and analyzes issues to prevent recurrence.
- Provides education, guidance, and training to employees regarding incidents, complaints, and potential fraud events.
- Engages in Administrative Reviews and Certified Investigation Peer Reviews to ensure processes meet regulatory standards.
- Establishes rapport with staff, caregivers, clients, providers, families, and outside agencies to coordinate investigations.
- Compiles, trends and reports quality data to analyze why incidents occur and how recurrences can be prevented.
- Assists the Director of Quality & Clinical Management in the administration of the agency’s quality improvement plans, infection control program, and accreditation standards.
- Assists the Compliance Officer in monitoring the agency’s compliance with regulatory mandates. Assists with the preparation of plans of correction for state surveys and auditing bodies.
- Performs other duties as assigned by the Chief Compliance Officer.
Compliance As Requirement Of Performance
Compliance with AmeriBest policies and procedures is a responsibility of all AmeriBest associates. It is a part of each associate’s performance to follow these requirements:
- All associates are expected to participate in any investigatory activities
- All associates are expected to report any violation of AmeriBest policies and procedures
- All associates are expected to conduct themselves in an ethical manner consistent with the AmeriBest mission statement and Standards of Conduct
- All associates are expected to protect the privacy of protected records and must conduct themselves consistent with all applicable laws and policies regarding privacy protection, including HIPAA and state specific privacy laws
Competencies/Skills
- Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently.
- Process Building – seeks to develop better efficiencies in agency processes. Actively engages in the use of technology to automate and enhance day-to-day workflows.
- Problem solving – effective at identifying root causes and creative solutions to issues.
- Analytical – strong quantitative and analytical skills. Apply critical thinking to make informed, data driven decisions.
- Teamwork – ability to work effectively as part of a team
- Communication – Communicates effectively and concisely; Strong ability to create effective visual summations of data.
- Customer focused – strong customer service skills, able to deal with people in a polite and caring manner.
- Strong Computer Proficiency- Uses Microsoft 365 applications with proficiency. Intermediate to advanced skillset preferred in Word, Excel, Forms, and PowerPoint, Familiarity with EMR and data repository systems.
- Some Clinical Knowledge- Knowledge of medical terminology, familiarity with medical notes and discharge reports, and common chronic illnesses.
- Attention to Detail with Quality Focus.
- Deadline Oriented
Education And/Or Experience
- A bachelor's degree in social work, behavior sciences, human services, or a related field.
- At least one (1) years’ experience in home care, social work, case management, or hospital discharge planning.
Preferred Experience
- Associates Degree
- Prior experience working for a Home Health Care Agency
- One (1) year of experience in a healthcare organization
Additional Requirements
- Must have and maintain a valid Driver's License, a good driving record, maintain automobile insurance coverage, and have access to a reliable automobile.
- Ability to work occasional evenings and weekends to conduct investigations in client homes.
- Currently hold a PA-Office of Development Program (ODP) Certified Investigator certificate or must successfully complete this certification within 12 months of hire.
Physical Demands
- Regular requirement to sit; use hands to touch, handle or feel.
- Regular requirement to stand; kneel, squat, walk and reach with hands and arms.
- Occasional requirement to lift and/or move up to 10 pounds.
- Vision abilities include close vision, peripheral vision, depth perception and the ability to adjust focus.
- Able to travel throughout Philadelphia and surrounding counties and enter clients’ homes.
Work Environment
- Location: In-office position (Philadelphia office)
- Business Office Environment
- The noise level is usually moderate
- Local travel to client homes in the five county Philadelphia area
Benefits
- PTO
- Medical, Dental, and Vision Insurance
- 401(k) and HSA
AmeriBest Home Care is an equal opportunity employer. We value and encourage diversity in our workforce and provide equal employment opportunities to all individuals protected by applicable laws.
