Clinical Quality Assurance Reviewer

MPHI is a Michigan-based and nationally engaged, non-profit public health institute. We are a team of teams, process and content experts, dedicated to building A world where tomorrow is healthier than today!

This position is responsible for conducting comprehensive on-site record reviews, home visits, and clinical quality assurance audits for the MI Choice Home and Community-Based Services program, ensuring compliance with federal standards and safeguarding the health, safety, and welfare of participants through effective collaboration with MDHHS and related agencies.

• Maintain required licensure as a registered nurse or social worker.
• Conduct comprehensive Clinical Quality Assurance Reviews at MI Choice waiver agencies by evaluating clinical records and performing in-person home visits to assess participant health, safety, and welfare.
• Establish scheduled review appointments with each waiver agency in adherence to MI Choice program requirements and MDHHS protocols.
• Prepare and submit detailed quality assurance reports to MDHHS within established timelines while maintaining clear communication regarding any delays.
• Collaborate with team members and MDHHS to monitor compliance, follow up on audit findings, and enact corrective actions.
• Audit clinical records and issue citations based on federal performance standards and established protocols.
• Utilize clinical expertise to assess participant needs and determine necessary resources to maintain independence.
• Represent the best interests of MPHI at all times.
• Additional duties as assigned.

• Bachelor's degree in Nursing, Social Work, or a related field required.
• 5-7 years of experience in quality assurance, home or community-based care, case management, or record reviews required.
• Experience in conducting in-person home visits and comprehensive clinical audits preferred.
• Valid Michigan licensure as a registered nurse or social worker required.
• Valid Michigan driver's license required.

• Demonstrate in-depth knowledge of MI Choice Waiver programming and adherence to federal, state, and local mandates.
• Apply clinical expertise and critical thinking to conduct detailed record and home visit reviews with consideration of social, emotional, cognitive, behavioral, and environmental factors.
• Utilize excellent oral and written communication skills to effectively interact with participants, MDHHS staff, and other stakeholders.
• Exhibit strong organizational skills and time management while working independently and collaborating with team members.
• Leverage leadership abilities and adaptability to refine audit processes and support continuous quality improvements.
• Analyze data trends accurately to inform compliance strategies and corrective actions.
• Incorporate principles of equity, diversity, and inclusion in all professional interactions.

• Constantly required to exchange accurate information.
• Constantly operates a computer and other office machinery.
• Constantly observes details at close range.
• Frequently remains in a stationary position.
• Occasionally moves about inside an office.
• Occasionally moves office equipment weighing up to 25 pounds.

This job is performed in an indoor office environment and involves regular use of computers and other standard office equipment. The work environment may include limited exposure to moderate noise levels. May require travel.

MPHI works with you to promote health for everyone. Together, we will build a world where tomorrow is healthier than today!

MPHI is an EEO employer that participates with e-verify.