File Review Jobs in Silver Spring, MD (NOW HIRING)

Hillcrest Children & Family Center is a non-profit organization dedicated to the provision of comprehensive, evidence-based mental health services in Washington, DC. We are committed to fostering community awareness, eliminating systemic barriers, and delivering compassionate, high-quality care to individuals navigating mental health challenges.

The Quality Improvement Manager is responsible for overseeing/coordinating the activities designed to improve quality of care and compliance throughout the organization. This role ensures that all programs consistently meet internal benchmarks and external regulatory requirements through rigorous data collection and auditing. By analyzing performance trends, the manager leads action plans and staff training to foster a culture of continuous organizational growth.

Key Responsibilities:

• Creates and maintains QI Compliance work plan that tracks & details the actions necessary to comply with federal, state, best practices and business standards.
• Performs research and analysis of all health care reform and movements and other regulatory changes.
• Determines the appropriate updates for work plans and ensures that each quality leader/manager is responsible for pertinent standards/activities are meeting requirements. These activities include, but are not limited to: data collection, quality of care complaint resolution, medical record reviews, office site evaluations and analysis of various clinical and organizational service indicators (e.g. effectiveness of care measures, service delivery results, work productivity, practitioner availability and accessibility analysis).
• Coordinates with designated quality leaders/managers within the organization to ensure that actions (creation/revisions of policies/procedures, program descriptions, marketing/member materials, etc.) necessary for compliance are being carried out.
• Determines and directs revisions to the tasks as necessary to ensure program compliance with specified regulations and standards.
• Provides a professional mentoring environment in which an employee is encouraged and challenged to expand their skill sets and knowledge.
• Coordinates with designated staff and other managers, as applicable, to develop committee agendas, ensuring that all necessary documents, policies and reports are presented and approved at the various Quality Improvement Committees and sub-committees.
• Oversee internal auditing functions of file reviews (Quality of Care Complaints, Customer Service Complaints, Appeals, Utilization Management) to determine compliance with federal, state and external regulations.
• Examines file review results and develops actions for improvement for implementation by appropriate staff and management personnel.
• Reviews all QI documents (Program Descriptions, Work Plans, Policies and Procedures) as well as documentation from any delegated entities to ensure that all components necessary for compliance are included.
• Capable of providing staff orientation, staff development and training on treatment planning, documentation and compliance regulations.

Educational Requirements:

• Bachelors degree or equivalent in a health related field; Master's degree preferred; Quality improvement experience including accreditation and auditing experience, or a minimum of 3 years of related experience and/or training; or equivalent combination of education and experience in lieu of Master's degree.
• Minimum 3 years of experience in a behavioral health or community health setting is strongly preferred
• Candidates with active clinical licensure in District of Columbia (LPC or LICSW) are encouraged to apply
• Experience in principles of Quality Improvement, NCQA Standards, and Accreditation and Certification processes.

• Affordable Medical, Dental, and Vision insurance.
• 401K Retirement Plan and Life Insurance.
• Generous Paid Time Off (PTO), Sick Leave, and Paid Company Holidays.
• Opportunities for leadership training and professional development.
• Employee Assistance Programs (EAP) to support your professional and personal well-being.

Salary Range: $80,000 to $90,000