Fraud Review Analyst Jobs in Ridgefield, CT (NOW HIRING)

Purpose: The Supervisor of Incident Management will align his/her scope of work with Jawonio's Mission, while incorporating Jawonio's Core Values as the guiding principle for all work activities.
Summary: Under the direction of the Chief Compliance Officer, the Supervisor of Incident Management will develop and implement quality assurance and effectiveness of the Corporate Compliance/Quality Assurance Department. Overseeing all aspects of Incident Management, reporting, assignment of investigators, review of investigatory reports (in collaboration with the Compliance Officer), Incident Review Committee (IRC) Chair and corrective actions oversight.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
• Coordinate all aspects of Incident Management with the oversight of the Compliance Officer, ensuring regulatory compliance and timeliness to meet regulatory deadlines, including the corrective action plans are complete and submitted in a timely manner.
• Demonstrating as the senior investigator, best practices for reportable incidents conduct, performance and written investigations. Conducting investigations in various divisions and departments.
• Assigns, trains and monitors the performance of Investigators in partnership with the Compliance Officer.
• Assists the Compliance Officer (Chair of IRC) with preparation for Incident Review Committee Meetings, ensuring all regulatory requirements are met.
• Develop, review, analyze and improve internal controls and monitoring systems.
• Design systems to ensure ongoing staff monitoring of compliance with regulatory standards.
• Provide support to Program Directors regarding service delivery and regulatory compliance.
• Evaluate QI data from Agency audits and quality reviews; analyze data for patterns and trends; develop and implement action plans that address quality issues.
• Provide training and support to program staff to address quality needs
• Work collaboratively with the Corporate Compliance Officer and staff to create policies and procedures to ensure consistent quality improvement.
• Keep current up with all federal and state laws and regulations; perform follow-up evaluations of data and organizational performance.
• Chairs Open Corrective Action Plan (CAP) and Internal Investigation discussion meetings
• Co-Chairs (with the Compliance Officer) the Policy and Procedure Committee
• Provide technical assistance to the program directors/managers as needed to ensure corrections.
• Assist the Compliance Officer with annual report and annual trend analysis.
• Assist in the delivery of agency wide mandatory training utilizing standardized modules.
• Attend all regulatory training on incident management from OPWDD/OMH/Justice Center/SED/OCF
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
• Bachelor's Degree from an accredited college or university in public health administration, human services, nursing, social welfare, or a related field, with Master's degree preferred
• 5+ years of experience working in an organization that provides services to individuals with special needs
• Strong incident management experience required, particularly in OPWDD-regulated settings, including demonstrated proficiency with IRMA, incident reporting, investigation, follow-up, and corrective action processes.
• Strong clinical, management and organizational skills
• Knowledge of applicable program standards and regulations
• Proficiency in implementing and maintaining compliance standards
Communications skills:
Frequent contact with internal & external employees of all levels, and other agencies serving the disabled at large; other federally funded agencies; contact with consumers, advocates and stakeholders.
Computer Skills:
Working knowledge of all Microsoft programs, including PowerPoint.
Work Environment:
Travel to and from designated internal and external facilities, and to alternate training sites and conferences, as defined by agency.
Additional Requirements:
• Daily access to an automobile is required.
• A valid NY State Driver's License and ability to drive and driving record acceptable for agency insurance coverage are required.
• Must be cleared/maintain acceptable record under NY state mandated criminal background check process
• Must be clear and maintain an acceptable record under the Medicaid Fraud & Abuse clearance process.
• On-going training/education as part of development related to position. Programs are regulated by OPWDD, OMH, OCFS, SED, DOH and NYS Justice Center.