Quality Management Specialist (QMS)
The QMS is a contracted entity with DOH and reports directly to DOH Waiver Management staff. The contractor for the services of the QMS is separate from that of the RRDC. The QMSs are located in three (3) designated regions across New York State (refer to Section XIII – QMS Regions map).
The QMS promotes the Quality Management Program in the NHTD waiver program to ensure the delivery of high quality services to the participants. The QMS is a liaison between DOH, RRDCs, RRDSs, NEs, SCs and other waiver providers, and waiver participants regarding the NHTD waiver. The QMS can not provide waiver services.
The QMS has the right to access all records regarding a participant's or a provider's activities related to the waiver and has the right to meet with the participant at any time or place with his/her permission. The QMS works closely with DOH Waiver Management staff to provide data and input as needed regarding the administration of the NHTD waiver in their region.
The QMS must have:
- Knowledgeable about the operation of 1915 (c) waivers and community-based services;
- Professional experience working with people with disabilities and/or senior;
- Experience in developing and implementing quality management programs;
- Knowledgeable regarding issues concerning individuals with disabilities and seniors;
- Experience supervising professional staff;
- Experience in person/centered planning and team building;
- Ability to review and analyze records;
- Working knowledge of community-based resources for individuals with disabilities and/or seniors;
- Skill in analyzing reports or surveys to determine trends;
- Skill in program development;
- Working knowledge of benefits provided by Medicaid, Medicare and/or other third party payers;
- Excellent communication and presentation skills; and
- Meet all additional qualifications outlined in the QMS contract.
Roles and Responsibilities of the QMS
QMS responsibilities include:
1. Incident Reporting
- Oversee the SRI process, assuring compliance with the reporting process and the timely completion and submission of all required documentation associated with the investigatory process;
- Notify DOH in all appropriate situations of alleged abuse or neglect, or when a participant dies or at any time DOH involvement in the investigation process is warranted;
- Determine whether a SRI is closed or deemed open for further investigation, utilizing the RRDS in consultation as needed;
- Conduct follow-up contacts with the participant and/or legal guardian to assure satisfaction with outcome of investigation; and
- Track all pertinent information pertaining to SRIs for analysis to identify any regional trends and emerging issues.
2. Quality Monitoring
- Assist in the annual random retrospective review of a sample of Participant records as part of the NYS Quality Management Program and to confirm adherence to proper authorization procedures and satisfaction of federal review requirements;
- Perform trend analysis identifying problematic areas, and develop activities that will support positive outcomes;
- Assure the completion of annual Participant Satisfaction Surveys of waiver participants using the DOH designated form to assess participant satisfaction with the NHTD waiver and to monitor quality assurance activities;
- Arrange and facilitate annual Regional Forums to gather and discuss waiver related issues in the QMS region;
- Attend quarterly DOH meetings in Albany and at other times/places upon the request of DOH; and
- Attend Quality Advisory Board meetings to determine areas of intervention, training, participant satisfaction and programmatic changes.
3. Review of Service Plans
- Review all Service Plans over a specified dollar amount ($300 per/day) determined by DOH and provide recommendations to the RRDCs; and
- Assist RRDS in reviewing Service Plans upon request to assure information is accurate and meets the health and welfare needs of the participant.
4. Development of Community Resources
- Refer any potential provider(s)to the RRDS;
- Provide trend analysis to DOH regarding provider capacity and capabilities in their regions; and
- Promote the quality and availability of services.
5. Information and Resource
- Assist the RRDCs with outreach and dissemination of information to the community when requested or as appropriate to his/her role; and
- Refer all calls received from individuals, family members, advocates, professionals and others requesting information regarding the NHTD waiver to the appropriate RRDS for timely response.
6. Develop and Submit Reports to DOH
- Review quarterly reports from RRDCs in the QMS region;
- Review all reports submitted by provider agencies' Serious Incident Review Committee; and
- Submit quarterly and annual reports to DOH summarizing QMS activities which include: findings from Participant Satisfaction Surveys, SRIs and Recordable Incidents, SP reviews, regional trends and needs analysis, quality assurance activities and improvements, cost savings, and progress made toward attaining the program objectives articulated in the QMS contract; and
- Make recommendations to DOH based on experience for improvements to NHTD waiver policies and procedures.
7. Technical Assistance to other QMSs, RRDC, RRDS, Providers, and the DOH
- Provide cross training and technical assistance and share areas of expertise with other QMS's and the RRDC's in their region as requested;
- Provide training to waiver provider agencies as requested by RRDS; and
- Provide information and assistance to DOH as requested.
8. Other Roles and Responsibilities as Defined by DOH
- Conduct evaluations upon request of DOH that reflect a possible system-wide concern. Provide outcomes and recommendations to DOH.