Savannah or Columbus AreaSUMMARY The State Quality Improvement/ Compliance Director is a leadership position responsible for quality improvement and compliance activities for the individual’s respective state/s. This person performs their job duties under only general supervision, and is expected and required to regularly exercise their discretion and independent judgment. This person is responsible for maintaining (developing and overseeing) the state’s compliance and quality programs to assure conformity and adherence with all applicable state and federal laws and regulations, as well as program or payor standards and expectations in addition to implementing the state and national compliance and QI Plans. This person promotes, coordinates, and/or performs quality improvement monitoring and evaluation of programs and staff; assists leadership to develop monitoring oversight and control; and conducts regular review and reporting on compliance and quality-related activities. This person provides oversight to internal audits; responds to external audits; conducts investigations regarding compliance concerns; and oversees the development of corrective action/quality improvement plans. This person oversees the training of staff in compliance and quality improvement concepts and provides consultation and monitoring of staff members’ efforts to meet established quality improvement criteria. This person serves as the assigned state’s HIPAA Privacy Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES • Evaluates, develops, implements and maintains the state’s Compliance and Quality Improvement Plan, policies, procedures and any related forms necessary to document the state’s Compliance and Quality Improvement activities • Develops and oversees the monitoring plan and associated monitoring tools and reports • Is the Chairperson for the state PQI Committee; creates agendas, facilitates discussion, ensures documentation of meeting minutes • Serves as liaison to, and oversees all National Compliance and Quality initiatives (i.e. the National Chart Review, QI Calls to Consumers, PDSA and the HIPAA Privacy Self-Assessment and analyzes/determines need for follow-up • Provides oversight of the quality of documentation of service providers so that documents (reports, assessments, progress notes, treatment plans, evaluations, etc.) are thorough and completed in a timely manner • Reviews or oversees the review of a sample of client charts on an ongoing basis for compliance and quality according to appropriate state, payer and contract standards • Assists leaders in identifying and investigating known or suspected quality or compliance-related concerns and makes recommendations Pathways Job Description State QI / Compliance Director Georgia VP of Quality Improvement or Regional QI / Compliance Director Exempt State QI / Compliance Director Revised 02/21/23 • Oversees compliance related investigations by determining the scope of the investigations; finalizing documentation; making recommendations and partnering with shared services to develop a mitigation and improvement plan. • Oversees the collection, aggregation, analysis and reporting out of data and trends pertinent to compliance, quality improvement, program performance, clinical risk management and customer satisfaction • Develops and presents reports to state leadership; shares reports with senior leadership • Identifies gaps and training needs of staff; develops and trains (or oversees the training) on compliance issues. • Provides or oversees the provision of data-driven trainings for staff and management in areas of quality and compliance • Monitors and reports on annual compliance related training and other mandatory trainings per company and regulatory/contract requirements • Participates in the internal audit (monitoring) process and provides guidance to operations in the development and implementation of corrective action plans/performance improvement plans • Serves as liaison to regulatory entities and attends payor/provider meetings as needed • Has specialized and technical knowledge of local, state, and federal regulations and has expert knowledge in payor requirements, stays current on changes, works with programs to incorporate rules/regs into practice. • Serves as liaison to contractual audit requests and assists the programs in preparing for external audits and responding to results • Serves as liaison and project coordinator for national accreditation (COA,CARF, etc.) or other state accreditation processes, as applicable • Serves as designee for regulatory reporting requirements, including but not limited to HHS and Incident and/or Unusual Occurrence reporting • Serves as liaison to legal (internal and external); Develops the state's risk management plan and tools; assesses level of risk and involves legal, insurance, HR, etc. when needed. Determines actions for mitigating areas of risk. • Participates on the EHR development team for EHR modifications and improvements; acts as a point of contact for Pathways EHR related questions • Conducts ongoing risk assessments and uses data and trends to advise leadership and guide decision-making. • Partners with Human Resources to identify appropriate follow-up for those not adhering to established Compliance/QI guidelines • Serves as the state expert on state and regulatory requirements for state licensure and Medicaid/Medicare certification and re-certification • Reviews contracts, MOU's, and MOA's for compliance content; provides feedback on content and determines necessity of BAA. • Oversees Clinical Risk Management activities (including PHCS and state-required Incident Reporting) and escalates appropriate reports to the National Compliance; determines need for follow-up and ensures this occurs • Promotes and maintains confidentiality, and is well-versed in the Health Insurance Portability and Accountability Act (HIPAA) • Reviews and provides guidance on all subpoenas and court orders; responds to questions about client access and amendment of charts; manages inquiries from law enforcement; coordinates with Chief Privacy Officer; Oversees HIPAA incidents • Develops policies and procedures (in collaboration with State Director) that support compliance and quality improvement activities and assists with the roll out and enforcement of these policies and procedures State QI / Compliance Director Revised 02/21/23 • Participates in and/or oversees an annual review of state’s policies and procedures to ensure they are in line with current rules, requirements, and processes; ensures policy changes are tracked and old versions are maintained on file • Maintains the state’s policies and procedures and ensures they are accessible to all employees • Executes special projects as needed • Serves as the State Privacy Officer (SPO) for assigned state (see separate SPO job description) • Participates in the QI/Leaders Meetings; may serve on national committees; Represents QI/Compliance on State Leadership meetings and other local meetings. • May be responsible for the direct supervision of other designated QI/Compliance staff within their assigned state. WORK ENVIRONMENT • The noise level in the work environment is usually moderate. • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. TRAVEL • This position requires travel of up to 25% of the time. Travel may be required within the assigned state/s REQUIRED SALARY RANGE

$60,000-$65,000/year

EDUCATION AND/OR EXPERIENCE • Bachelors Degree Required • Minimum 5 years of experience in a QI or Compliance related position or behavioral health operations leadership experience or some combination of the two. • Minimum of 2 years of supervisory experience required. PREFERRED EDUCATION AND/OR EXPERIENCE • MHA, MBA or other Master’s Degree is preferred • Clinical licensure is preferred CERTIFICATES, LICENSES, REGISTRATIONS • Valid driver's license and proof of automobile insurance. State QI / Compliance Director Revised 02/21/23 • Certified HIPAA Professional is required within first 12 months of employment QUALIFICATIONS • Language Skills Ability to read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or complaints. Ability to write speeches and articles using original or innovative techniques or style. Ability to make effective and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors. • Data Analysis Skills Ability to analyze and interpret quality, compliance, and outcomes related data. Ability to detect trends and assess compliance related risks. • Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. ADDITIONAL ELIGIBILITY QUALIFICATIONS • Microsoft Office suite (Excel, Word, Outlook) • Project Management Skills • Mentoring/Supervisory skills • Ability to work as team member • Organizational skills • Communication skills • Ability to travel and work at multiple locations • Understanding of systems of care and reimbursement structure

Flexible work from home options available.