[Hiring] Quality Assurance Administrator @COLUMBUS MEDICAL SERVICES LLC

Role Description

The Quality Assurance Administrator supports quality assurance oversight for Case Management services by monitoring compliance with Medicaid requirements, state regulations, accreditation standards, contractual obligations, and organizational quality expectations. This role conducts record reviews, analyzes performance data, monitors corrective actions, identifies quality trends and risks, and supports continuous quality improvement initiatives.

• Administer and support the Quality Assurance (QA) and Continuous Quality Improvement (CQI) program for care coordination services.
• Conduct quality reviews of support plans, case records, and related documentation to ensure completeness, clinical appropriateness, accuracy, and compliance with organizational, contractual, state, and federal requirements.
• Coach Field Care Coordinators and provide guidance to supervisors on documentation quality, compliance expectations, and corrective actions.
• Submit finalized support plans to state agencies, as applicable.
• Monitor compliance with contractual deliverables, service timelines, documentation standards, policies, procedures, and regulatory requirements.
• Monitor the timeliness, completeness, and quality of required plan submissions and provide second-line quality assurance oversight and escalation as needed.
• Communicate quality review findings, documentation deficiencies, risks, and recommendations to leadership to support corrective action and performance improvement.
• Analyze quality, performance, complaint, grievance, incident, satisfaction, and audit data to identify trends, risks, training needs, and opportunities for improvement.
• Prepare quality assurance reports, dashboards, and regulatory submissions for leadership and external stakeholders, as required.
• Support audits, record reviews, monitoring activities, and the collection of documentation required to demonstrate quality performance and contractual compliance.
• Partner with leadership, supervisors, and training staff to identify root causes, implement corrective actions, and evaluate the effectiveness of quality improvement initiatives.
• Conduct follow-up reviews and monitoring activities to verify corrective actions are implemented, sustained, and effective.
• Escalate significant or recurring quality and compliance concerns through established governance channels, including referral to Compliance when appropriate.
• Engage with participants, families, and guardians, as appropriate, to address quality concerns, promote participant rights, support resolution efforts, and improve satisfaction outcomes.
• Ensure participants are informed of complaint and grievance procedures and that feedback is incorporated into quality improvement activities.
• Participate in the development, implementation, annual review, and ongoing monitoring of quality assurance and CQI processes.
• Maintain governance-ready quality documentation, corrective action records, audit evidence, and leadership reporting to support regulatory, contractual, and organizational requirements.
• Complete required training and support organizational readiness for audits, accreditation reviews, and quality monitoring activities.

Qualifications

• Bachelor’s degree from an accredited institution in Human Services, Behavioral Sciences, Social Sciences, or a related field.
• In lieu of a degree, four (4) or more years of experience in a relevant field may be considered.
• Minimum of three (3) years of experience in quality assurance, auditing, or quality improvement within healthcare, Medicaid, HCBS, or developmental disabilities services.
• Experience in case management or developmental disabilities services strongly preferred.

Requirements

• Knowledge of Medicaid, HCBS, and state policies and regulations.
• Strong analytical skills with the ability to identify trends and develop clear reports.
• Experience developing and monitoring corrective action and quality improvement plans.
• Proficiency in Microsoft Office 365 and electronic record systems.
• Excellent written and verbal communication skills.
• Strong attention to detail, accountability, and ability to work independently.
• Ability to engage professionally with participants, families, and multidisciplinary teams.
• Strong organizational skills with the ability to prioritize and meet deadlines.

Benefits

• Remote position in Vermont.
• Occasional evening or weekend work may be required based on program needs.