Quality Assurance Investigation Specialist

POSITION SUMMARY:

Reporting to the VP of Program Quality Assurance and Compliance, the Quality Assurance Investigations Specialist responds to all incident reports and complaints, processing each according to internal and external policy requirements. The position conducts all aspects of the agency incident reporting and investigation process while serving to monitor compliance with internal and external quality assurance standards and regulations. The position is responsible for conducting unbiased investigations and delivering conclusions and recommendations for corrective actions, to the program leadership. The position attends the agency QA oversight committee (Human Rights Committee), completes relevant reports, and completes other quality assurance/compliance functions in support of the Program QA & Compliance department as needed.

ESSENTIAL RESPONSIBILITIES:

• Receive all programmatic incident reports and conduct proactive reviews to ensure clarity, accuracy, and completeness.
• Assess all incident reports to determine incident category and process according to regulatory requirements and internal policy.
• Complete all regulated external reporting per the required timeframes.
• Conduct programmatic incident investigations in a systematic and timely manner.

• Maintain current knowledge of relevant COMAR regulations and accreditation standards and internal policies and procedures to ensure correct application of requirements to investigatory process and conclusions.

• Prepare written reports of programmatic incident investigations to include investigation process, findings, conclusions, and recommendations.
• Disseminate written investigation reports to the appropriate leadership personnel and augment with in-person/verbal presentation when necessary.
• Receive formal complaints and grievances from all sources and process according to internal policy.
• Maintain accurate records/documentation of all assigned processes including, workflow logs, incident reports, investigations, committee documents, written reports, and required external reporting documents.
• Work collaboratively with all departments to ensure timely follow through on incident reports, grievances, plans of correction, and other participant quality assurance issues/processes; provide guidance to programs on best practices for incident follow-up as needed.
• Participate in the coordination of the standing committee meetings to ensure programmatic incidents are reviewed and processed according to regulatory requirements by the committee.
• Prepare relevant documents for the standing committee to facilitate their review process and participate in standing committee meetings to provide clarification of incident reports and investigation conclusions.
• Serve as primary contact and host for external incident investigations; ensure all requested records are appropriately provided to investigators in a timely manner.
• Facilitate the organization/program response to incident related citations and deficiency statements; assist programs with producing acceptable Plans of Correction; submit Plans of Correction to the licensing body within the required timeframes.
• Compile and summarize incident report data; participate in the analysis of incident data with the program leadership.
• Develop and conduct staff training on incident reporting and investigations; including New Hire Orientation and ongoing re-training as needed.

QUALIFICATIONS:

• Bachelor's Degree in rehabilitation or a related field required.

• Master's Degree in related field preferred.
• LRA or other incident investigation certification and minimum two years experience conducting serious incident investigations.
• Minimum two years experience in health information, quality, utilization or risk management.
• Minimum of three years community rehabilitation experience required.
• Excellent writing skills; ability to create clear, unbiased, thorough written reports.
• Excellent communication skills; ability to listen and communicate effectively.
• Valid Driver's License and access to reliable transportation required.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

This position must have the ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations. While performing the duties of this position the employee will constantly operate a computer and other office productivity equipment. This position requires standing, moving, walking, sitting, reaching with hands and arms, stooping, kneeling, crouching, and the ability to drive agency vehicles. Frequently may be required to move/lift to 20 pounds. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.