Quality Assurance Specialist /remote in Oregon/

Here at GOBHI, we understand and support diversity by appreciating it and encouraging it by creating a culture of dignity and respect for our employees. We are honored to be an Equal Opportunity Employer.We have multiple ads, please only respond to one! Greater Oregon Behavioral Health, Inc. (GOBHI) has an immediate opening for a Quality Assurance Specialist. This position will be based out of the employee’s home office, which can be located within the State of Oregon. The Quality Assurance (QA) Specialist supports the mission of GOBHI by ensuring compliance with regulatory requirements and promoting continuous quality improvement across GOBHI’s programs and services. This role is responsible for implementing and maintaining quality assurance processes to monitor performance, identify areas of risk or non-compliance, and support operational excellence. The QA Specialist works cross-functionally with departments including Behavioral Health, Medicaid services, Child and Family Services, and Corporate Compliance to ensure high standards of care and service delivery. Essential duties include:

• Assist with the development, implementation, and monitoring of quality assurance policies, procedures, and tools aligned with GOBHI’s strategic goals.
• Conduct regular audits and reviews of, case files, data reporting, and internal processes to ensure accuracy, compliance, and quality.
• Analyze data trends and prepare reports to support performance improvement initiatives and regulatory requirements.
• Support internal and external reviews, including Oregon Health Authority (OHA) audits, Medicaid/CCO compliance checks, and External Quality Reviews (EQR).
• Collaborate with program leads and stakeholders to identify areas for improvement and assist in developing corrective action plans.
• Monitor compliance with GOBHI’s internal policies, federal and state regulations, and contractual obligations.
• Assist in the coordination and documentation of incident reporting, grievance tracking, and corrective action follow-ups.
• Help organize and support Performance Improvement Projects (PIPs) and Quality Improvement Committees (QIC).
• Monitor contracted provider performance related to the following functions, including member care and utilization management, grievance system, provider access, program integrity and enrollee rights.
• Provide training and technical assistance to internal staff and subcontracted providers on quality standards and documentation practices.
• Participate in annual risk assessment, to identify, evaluate and prioritize annual risk.
• Participate in quality team meetings and contribute to a culture of learning, accountability, and continuous improvement.
• Performs other related duties as assigned.

Requirements

What is needed to succeed in this role:

• Two years’ experience in quality assurance, compliance, healthcare, or human services setting.
• Strong understanding of quality improvement principles.
• Knowledge of Medicaid and Oregon Health Authority requirements is required .
• Strong interpersonal and communication skills; ability to work collaboratively across teams.
• Excellent time management, attention to detail, and organizational skills.
• Ability to communicate effectively at multiple levels.
• Proficient in Microsoft Office software and/or Google Suites software, especially Excel and data tracking tools.
• Maintains good driving record and required vehicle insurance.
• Working knowledge of current External Quality Review or quality performance measures.
• May require flexible hours to meet project deadlines or audit schedules.
• Education – Bachelor’s degree in Public Health, Social Work, Psychology, Healthcare Administration, or related field, equivalent work experience may be considered.

What we offer:

• Competitive salary – starting at $60,000.00 - $70,000 annually DOE
• Added compensation for bilingual skills
• Medical, dental and vision insurance for you and dependents
• Generous paid time off
• EAP
• FSA, with a $500 employer contribution
• Triple AAA insurance
• Mileage reimbursement
• Wellness benefits
• 401k contribution, including 6.5% employer contributions
• Cell phone and internet reimbursements

About GOBHI: Founded in 1994, Greater Oregon Behavioral Health, Inc. is an innovative behavioral health organization that serves communities across Oregon. GOBHI is a 501(c)(3) nonprofit corporation that is charged with administering the behavioral health Medicaid benefit, non-emergent medical transportation and community engagement in 12 rural and frontier counties in Oregon. GOBHI is a co-owner of the Eastern Oregon Coordinated Care Organization, along with Moda Health, and also provides various direct services statewide. GOBHI is committed to better health, better care, and lower costs. Please visit www.gobhi.org to learn more about our mission and services. Original job Quality Assurance Specialist /remote in Oregon/ posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs. Apply tot his job Apply To this Job