Job Description

Job Description

Job Description

Agency Profile: Spectrum Health & Human Services respectfully partners with adults, children, and families as they recover from behavioral, emotional, mental health and/or substance related disorders by offering individualized and meaningful opportunities of hope, empowerment and support to achieve self-defined improvements in their quality of life.

Full-time: 227 Thorn Avenue, Orchard Park, NY

SUMMARY OF POSITION FUNCTION:

The Quality Improvement (QI) Program Manager leads the agency’s quality improvement activities to ensure the delivery of high-quality behavioral health services that meet or exceed regulatory standards, contractual requirements, and best practice guidelines. This role directs the day-to-day operations of the Quality Improvement Department, including utilization review, audit coordination, performance measure monitoring, and continuous quality improvement initiatives. The position works closely with program leadership, data analytics, training, and compliance to identify improvement opportunities, implement evidence-based practices, and ensure agency readiness for regulatory and accreditation audits. The position provides leadership to QI team, fosters a culture of continuous improvement, and aligns quality activities with agency priorities and strategic goals.

MAJOR DUTIES AND RESPONSIBILITIES:

Quality Improvement Leadership

• Develop, implement, and monitor the agency’s Continuous Quality Improvement (CQI) Plan in collaboration with the Associate Vice President of Clinical Excellence.
• Lead and manage QI projects that enhance service delivery, compliance, and client outcomes.
• Co-Chair the agency’s Quality Improvement Committee (QIC) and coordinate QIC activities, tracking follow-up actions and outcomes.
• Identify quality improvement priorities based on data analysis, audit results, and stakeholder feedback.
• Assist in developing and revising agency policies and procedures related to quality and compliance.
• Directly supervises QI Department staff, including the Data Reporting Specialist and other assigned quality personnel.
• Provide leadership and meaningful input at agency meetings and workgroups.

Audit Management & Utilization Review

• Oversee the department’s utilization management process and coordinate internal audit activities.
• Build audit rosters based on regulatory requirements and staff assignments; manage audit tracking in SharePoint.
• Conduct and oversee EHR reviews and prepare associated analysis reports.
• Communicate audit findings and trends to program leadership on a monthly/quarterly basis.
• Monitor corrective action plan (CAP) progress, track compliance, and ensure timely follow-up on audit findings.
• Support programs in achieving compliance with OMH, OASAS, DOH, Medicaid, and payor audit requirements.
• Participate in licensing visits, accreditation surveys, and payor audits.

Performance Measures & Data Analytics

• Collaborate with the quality and data team to analyze data related to performance measures and quality indicators, working with data and analytics teams to identify trends and improvement opportunities.
• Utilize tools such as PowerBI and Excel to track, analyze, and present quality data.
• Provide regular reports and dashboards to leadership to inform strategic and operational decisions.
• Use performance data to identify potential QIC projects and continuous improvement initiatives.
• Support the integration of performance measures into program operations and quality monitoring.

Incident & Compliance Monitoring

• Review and track clinical incidents, making required external reports to OMH, OASAS, and the Justice Center.
• Facilitate the Special Review Committee to review incidents, trends, and corrective actions.
• Monitor compliance with reporting requirements for incidents, investigations, and other regulatory obligations.

Training & Development

• Collaborate with the Training Department to develop and deliver quality-related training for staff.
• Provide targeted training to programs based on audit findings, performance measures, and regulatory changes.
• Promote awareness and engagement in continuous quality improvement initiatives across the organization.

Stakeholder Engagement & Collaboration

• Work closely with program leadership, compliance, data analytics, and training teams to address quality and performance challenges.
• Engage with clients, families, and community partners to gather input and incorporate feedback into improvement strategies.
• Serve as a resource and liaison to regulatory agencies, accrediting bodies, and community partners regarding quality improvement activities.

SKILLS/COMPETENCIES:

• Knowledge of medically necessary documentation standards in behavioral health, case management, and care coordination.
• Understanding of federal, state, and local regulations, including OMH, OASAS, Medicaid, and accreditation standards.
• Knowledge of continuous quality improvement tools, strategies, and evidence-based practices.
• Strong data analysis skills and proficiency in Excel, PowerPoint, PowerBI, and other reporting tools.
• Excellent organizational, planning, and record-keeping skills.
• Ability to supervise and develop staff in a way that maximizes their potential.
• Strong verbal and written communication skills, including the ability to present concepts clearly to individuals and groups.
• Ability to work collaboratively in high-performing interdisciplinary teams.

EDUCATION REQUIREMENTS:

• Master’s degree in Social Work, Psychology, Nursing, Health and Human Services, or a closely related field.
• Must meet the OMH/OASAS Qualified Health Professional criteria.

EXPERIENCE:

• Minimum of three (3) years of direct clinical practice experience in behavioral health or a related healthcare setting.
• Preferred: Demonstrated experience in utilization review, performance measurement, and continuous quality improvement initiatives.
• Preferred: Prior supervisory or leadership experience overseeing clinical or quality-focused teams.

Must possess a valid Driver’s License with a satisfactory driving record, and possess a personal vehicle for job requirement

COMPENSATION: $60,000/yr - 75,000/yr

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