Quality Management Program Specialist

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Brief Job Description:

Works under limited supervision with considerable latitude for use of initiative and independent judgement. Works as a team member planning, developing, implementing onsite and desk reviews and studies to determine service quality and compliance with contracts, grants, laws, regulation, policies, and procedures to continuously improve the quality and efficacy of services. Evaluates the services delivered to consumers and business functions for managing care, ensures the effective communication of findings to the customers, evaluates providers' plans of correction/improvement and conducts follow-up to determine if improvements have been made and maintained. Conducts assessment of multifaceted compliance information to determine monitoring needs and steps to bring a contractor into compliance. Performs Lead role in HHSC and unit initiative implementation. Designs, develops and implements effective policies and protocols for evaluation and monitoring of business functions and service delivery. Develops performance reports, conducts data analysis to evaluate the effectiveness of systems, standards, and policies. Studies and analyzes operations and prepares reports of findings and recommendations, prepares administrative reports, studies and specialized research projects. Produces professional, accurate communications, provides technical support and training related to compliance, quality management and identification of best practices, makes presentations and responds to inquiries from providers and the community. This position may be eligible for a hybrid or 100% telework schedule consistent with the HHS telework policy. Travel to regional HHS office for meetings, trainings, employee badge, and pick up or repair of HHS-issued equipment, may be required.

Essential Job Functions (EJFs):

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
EJF1. Plans, implements and functions as Review leader for onsite, desk, focused and statewide reviews to assess service quality and compliance with Mental Health and/or Substance Use Disorder contracts, grants, applicable Federal and state laws, regulations, policies, and procedures; and prepares the required reports or responses as appropriate. Maintains positive work relationships with internal and external stakeholders. Evaluates organizational systems, business functions and the quality and efficacy of services. Evaluates plans of correction/improvement, and conducts follow-up to determine if improvements have been made and are maintained, and works with contract manager/project officer to recommend sanctions and penalties. (40%)
EJF 2. Develops and implements policy and protocols for evaluation of business functions, service delivery and outcomes; employs quality management methods to collect, synthesize, analyze and use data in the process of facilitating continuous improvement within organizations providing Mental Health and/or Substance Use Disorder services. Conducts studies and specialized research projects, represents Quality Management Unit on workgroups to develop standards and processes for new agency initiatives within a team model. (15%) EJF 3. Participates in activities such as risk assessment to determine priorities for the deployment of oversight resources; performs analysis and interpretation of data to identify trends and best practices. Uses data and knowledge of the system to make recommendations to management and providers to improve the quality or efficiency of processes. Participates in performance measurement and identification of providers at risk of non-compliance with the contract or delivering poor quality Mental Health or Substance Use Disorder services. (15%)
EJF 4. Ensures communication of findings to Mental Health and Substance Use Disorder providers during review exits and technical assistance. Produces professional communications including but not limited to letters, technical reports, executive summaries, charts, graphs, minutes, memos, e-mails, slide show presentations. Responds appropriately to queries from the field, the public and within the agency and complaints regarding Mental Health and Substance Use Disorder programmatic compliance. (10%)
EJF 5. Provides consultation and technical assistance related to quality management, increasing compliance and effective oversight of contracts to managers, staff, LMHAs, providers and stakeholders maintaining positive work relationships with internal and external stakeholders. Provides training for QM staff and others within the agency, providers and members of the community in compliance, quality improvement, identification of best practices and the development of new methods and procedures. (10%)
EJF 6. Identifies methods to improve processes and the efficiency of unit activities. Participates in evaluations of interrater-reliability to ensure accurate and consistent findings. Plans, assigns, guides and oversees the work of BHS
QM staff when functioning as a project manager or team leader and is responsible for the efficient and effective deployment of resources within the team model. (5%)
EJF 7. Performs other duties as assigned. (5%)

Knowledge, Skills and Abilities (KSAs):

Knowledge of:

• The application of the principles of quality management for improvement of substance abuse services
• State, and federal laws, agency regulations, policies, rules and requirements pertaining to the provision of substance abuse services in the community 
• Laws and rules applicable to confidentiality and the management of protected health information
• Data systems for managing operations and making decisions

Skill in:

• Effective verbal communication and public speaking, and interpretation and presentation of complex data sets and analysis
• Project management with complex projects that cross agencies and several lines of business
• Identifying problems, evaluating alternatives, and negotiating and implementing solutions to organizational and service delivery problems
• Advanced business and technical writing, data analysis, reporting, and interpretation of complex data sets related to provider performance

Ability to:

• Organize and present information effectively, both orally and in writing
• Analyze and solve work problems affecting the operations and functions
• Provide information to providers regarding areas of non-compliance and less than acceptable quality in an informative non-threatening manner
• Plan, organize and manage large multi-faceted projects and work in collaboration with others to manage multiple deadlines
• Plan, assign and manage the work of others

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening Critiera: 

Bachelor's Degree with major course work in human service from a U.S. accredited college, university, or foreign degree determined to be equivalent by an acceptable education evaluator. Relevant experience may be substituted for education on a year-to-year basis. 

Additional Information:

Travel to Austin to on-board, establish credentials, and training, may be required.

Knowledge of Medicaid managed care programs, policies, procedures, contracts, and service delivery mechanisms desired but not required. 

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form