Position Summary:Under the direction of the DBHIDS Compliance Manager and the Senior Investigator in the Administration, Finance, and Quality Division at DBHIDS, the DBHIDS Investigator I is responsible for processing, investigating, reporting, tracking, and closing Incidents as outlined in the DBHIDS Significant Incident Management Policy, as well as investigating DBHIDS formal complaints. The successful candidate will manage Significant Incidents involving recipients of services from contracted DBHIDS providers, and will ensure Significant Incidents are responded tothoroughly, effectively, and in a timely manner.The DBHIDS Investigator I is a cross-functional team member, coordinator, and leader who must possess strong clinical acumen and be able to foster continuous quality improvement. This resourceful team member will investigate incidents, assist with overcoming barriers, and ensure all parties required are contacted within specified timelines.The DBHIDS Investigator I is responsible for the coordination and ongoing monitoring of Incidents' reporting program objectives, including timely identification, reporting, investigation, review, and closure of the Significant incident process in the Pennsylvania Enterprise Management System (ElM).Duties and Responsibilities:
- Serves as the DBHIDS Significant Incidents Investigator.
- Serves as the DBHIDS Formal Complaint Investigator.
- Contributes to the overall incident processes including reporting, tracking, metrics, and process improvement.
- Responds to Incidents thoroughly, effectively, and in a timely manner.
- Conducts independent investigations of an assigned incident pursuant to the Formal Complaints and Significant Incidents investigation policies and state regulations.
- Obtains relevant information and evidence, interviews witnesses, providers, and other parties to collect and analyze all information with the objective of generating a written report containing factual findings and conclusions.
- Reviews medical records and other collateral information to recommend follow-up actions needed to mitigate risk and prevent further incidents from occurring.
- Supports organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory, and accrediting body's standard requirements.
- Identifies and reports to appropriate leadership instances of provider non-compliance in accordance with scope of work, standard operating procedures, Requests for Proposals (RFPs) and contract requirements.
- Facilitates and monitors the Significant Incident process in collaboration with providers and cross divisionally ensuring timely and accurate completion of the Significant Incident process with the goal of ensuring health and safety and mitigating future risk.
- Documents findings in electronic systems and actively record all activities on open cases in a timely manner.
- Provides incident summary responses both orally and in writing.
- Prepares and submits periodic reports of program activities and achievements.
- Compiles data and information to be used to recommend program improvements to leadership.
- Builds and sustains relationships with all internal and external stakeholders.
- Attends meetings and proactively communicates across the department to identify, address, and manage Significant Incidents interdependencies.
- Identifies problems, mediates issues, develops solutions, and implements a course of action.
- Interlaces with Criminal Justice System including Court appearances as necessary. 'Maintain valid Commonwealth of Pennsylvania Office of Developmental Programs (ODP) Certified Investigator Certification and Recertification
- Supports requirements of management and change management processes.
- Demonstrates knowledge of functional area policies, procedures, processes, and standards.
- Other duties as assigned
Skills Required:
- The ideal candidate will have a working knowledge of PA state regulations, Behavioral Health Managed Care, and Philadelphia's behavioral health services.
- Comprehensive knowledge of mental health services for adults and children
- Drive for excellence, teamwork, and commitment to service
- Excellent organizational, analytical, and interpersonal skills
- Strong critical thinking and problem-solving skills.
- Ability to work successfully within all levels of the organization
- Strong computer skills, including Competency in MS Word, Outlook, Excel, and web-based healthcare applications
- Ability to manage multiple tasks while effectively focusing on priority issue
- Successfully meet deadlines and manage multiple priorities in a fast-paced environment.
- Demonstrates high stress tolerance and strong time management skill
- Exercises good judgment and business acumen
- Ability to work independently
- Excellent interpersonal and professional communication skills, both verbal and written
- Ability to work as a member of a team and cross-functionally within the organization
- Excellent troubleshooting and problem-solving skills
- Ability to communicate with stakeholders and form partnerships to improve alignment, collaboration, and integration
- Ability to adapt and be flexible in changing priorities
Education and Experience:
- The ideal candidate must possess a strong clinical background with a Bachelor's degree in Human Services, Criminal Justice, or Social Work, and one of the following:
- Three (3) to four (4) years of experience in Human Services Delivery, Criminal Justice, or Law Enforcement, or
- Three (3) to four (4) years of experience in Protective Services, or Fraud Investigations.
- Proven ability to work in a fast-paced environment.
- Quality improvement knowledge desired
- Knowledge of commercial, Medicaid products, managed care principles, and home and community-based services desired.
Physical Demands:
- Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day
- Requires continuous, normal hearing and vision to exchange information
- Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed
- Dexterity of hands and fingers to operate office equipment
- Must be able to adapt to continuous changes/ demands of the job
Essential Functions:
- Must have a valid driver's license, auto insurance, and the ability to travel to different locations within the city and other counties (as necessary) to interview witnesses, review documentation, etc.
- Ability to work weekends and holidays in meeting state and federal regulatory and policy requirements.
- Ability to physically perform the duties and to work in the environmental conditions required such as maneuvering in office space, reaching file cabinets, fax and copier machines when necessary.
- Must be able to sit for up to two (2) hours looking at computer monitor and using a keyboard and mouse to perform data entry functions.
- Ability to travel locally via personal vehicle, public transportation and on foot between PMHCC offices or other destinations as needed.
- Ability to effectively utilize computers, databases and related common office software packages, such as Microsoft Word, Excel and Access.
- Ability to share office space and work as a part of a team.
Equal Opportunity Employment:PMHCC, Inc. is committed to equal opportunity. It is our policy to support equal employment for all employees and applicants without regard to race, religion, color, sex, sexual preferences, age, national origin, disability, behavioral health status, military status or any other characteristic protected by law.Americans with Disabilities Act:Employees as well as applicants who are currently, or become disabled, must be able to perform the functions of the job with either reasonable accommodation or unaided. PMHCC, Inc. will examine reasonable accommodations on a case by case basis in accordance with the law.