Job Description

Job Location: Greensburg, PA 15601,

Position Type: Full Time,

SUMMARY

This full-time exempt position supports agency-wide compliance, quality improvement, performance measurement, service development, strategic initiatives, and grants through audits, data analysis, corrective-action monitoring, policy and process development, required submissions, technical assistance, and training. Working with the Quality Compliance Development Supervisor and Quality/Compliance Director, the specialist maintains compliance integrity, improves service quality and efficiency, identifies risks and opportunities, and supports responsible growth and innovation. The role requires strict confidentiality and supports Targeted Case Management, Targeted Support Management, County Funded Programs, and other funded services. Standard hours are Monday–Friday, 8:30 a.m.–4:30 p.m., with a 30-minute lunch (37.5 hours weekly), unless otherwise agreed. Work location may change with operational needs; a hybrid schedule may be offered after successful completion of the introductory period.

Compliance

As with all WCSI positions, it is the expectation that employees adhere to WCSI, County, State and Federal guidelines, regulation, policies, and laws which govern the business and service of WCSI.

This position requires the employee to perform their daily job duties and responsibilities in a structured work environment. All staff receive training and must comply with applicable HIPAA privacy and security standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Includes the following, (other duties may be assigned as deemed necessary by management):

Regulatory and Agency Compliance

• Stay current on federal, state, county, managed care, contractual, HIPAA, and program-specific requirements affecting WCSI services.
• Support the Quality/Compliance Plan, Whistleblower Policy, and related compliance processes.
• Assist with internal reviews, external audits, monitoring visits, investigations, revalidations, re-credentialing, and required regulatory submissions.
• Complete ODP certified investigator training to assist with agency investigative reviews as required.
• Develop and maintain program-based audit tools; conduct scheduled and focused audits; compile evidence, document findings, and prepare clear reports.
• Recommend and track corrective actions and process improvements, conduct follow-up reviews, and report unresolved or critical issues to leadership.
• Assess regulatory and legislative updates for operational impact and communicate relevant changes to affected departments.
• Maintain confidential compliance records and support conflict-of-interest reviews and risk management.

Quality Improvement and Incident Review

• Support continuous quality improvement and help departments turn findings into measurable improvement plans.
• Monitor quality indicators, incidents, documentation errors, provider paybacks, satisfaction results, and other performance measures for trends, risks, and improvement opportunities.
• Support incident reviews, root cause analysis, after-action recommendations, and closure monitoring.
• Help develop and review audit methodologies, quality standards, surveys, and monitoring tools annually.
• Coordinate or support Compliance Committee and subcommittee agendas, materials, minutes, confidentiality agreements, bylaws, and follow-up.
• Provide technical assistance and training promoting compliance, accountability, and continuous improvement.

Data Analytics and Organization Performance

• Develop and maintain tracking for internal and external audits, incident management, quality reviews, satisfaction surveys, corrective actions, provider paybacks, accreditation, and assigned initiatives.
• Compile, organize, calculate, tabulate, validate, audit, and analyze information while preserving data integrity.
• Prepare dashboards, summaries, audit and corrective action reports, and other written presentations for leadership and stakeholders.
• Identify trends, emerging risks, service gaps, and opportunities, and recommend data-informed actions.
• Collaborate with programs and administrative staff to improve data collection, reporting consistency, and performance measurement.

Policy, Accreditation, and Development Support

• Help draft, review, revise, and maintain compliance, quality, and agency operations policies and procedures.
• Support PANO Standards for Excellence accreditation and maintain required accreditation and monitoring documentation as needed.
• Coordinate and maintain assigned Medical Assistance initial enrollment and revalidation documentation under Quality/Compliance Development Supervisor oversight.
• Research community needs, service gaps, quality-management practices, and emerging trends to support new or improved services.
• Support feasibility reviews, outcome monitoring, and sustainability assessments for strategic initiatives.
• Help research funding opportunities and contribute to assigned grant applications, narratives, supporting data, project tracking, and required outcome reports.

Training, Collaboration, and General Responsibilities

• Develop and deliver orientation and training on compliance, quality, policies, processes, reviews, accreditation, and assigned regulatory topics.
• Build constructive cross-department relationships and communicate effectively in meetings, email, reports, presentations, and training.
• Use Microsoft Word, Excel, PowerPoint, databases, and other systems to organize work, analyze information, and communicate results.
• Organize assignments, set goals and timelines, balance priorities, and complete time-sensitive work using sound judgment.
• Attend required meetings and training, support agency initiatives, project management, and special assignments.
• Demonstrate professional judgment, confidentiality, accuracy, teamwork, and forward-thinking problem solving.

Perform other position-related duties assigned by the Quality Compliance Development Supervisor, Quality/Compliance Director, Chief Administrative Officer, or Chief Executive Officer.

Qualifications: 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 accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Bachelor’s Degree (BA/BS), with three (3) years of professional experience including experience in social services, compliance, quality assurance, program operations, data analysis, or a related field; or an equivalent combination of education, experience, and training, which demonstrate the knowledge, skills, and abilities required for the position. Direct experience with regulatory compliance, internal auditing, quality improvement, accreditation, or human-services programs is preferred.

Knowledge, Skills, and Abilities

• Knowledge of compliance and quality principles, regulatory interpretation, audit practices, corrective action monitoring, risk identification, and continuous quality improvement
• Ability to read and interpret complex written requirements; synthesize information; ask pertinent questions; exercise sound judgement; and form supportive conclusions.
• Strong analytical, organizational, project-management, report writing, presentation, and interpersonal skills.
• Ability to communicate clearly in writing and verbally, maintain sensitive records, manage frequent interruptions, and prioritize multiple responsibilities and deadlines.
• Ability to work independently and collaboratively while demonstrating integrity, accountability, respect, innovation, and attention to detail.

Certificates, Registrations, Licenses

Valid PA Driver’s License, Proof of Valid Auto Insurance, Act 34 (Criminal Record), and Act 33 (Child Abuse) and FBI Clearance. There will be monthly screenings of PA Medicheck List, LEIE (List of Excluded Individuals/Entities) and SAM (System for Award Management).

Other

As a requirement of employment, certain personal information (Birth Date, Driver’s License, Diplomas, Transcripts, etc.) can be shared in confidential communication as related to regulations, licensure, and/or insurance carrier contracts.

As with all WCSI positions, this position will adhere to all random drug screening requirements, as set forth by WCSI Policy.

ENVIRONMENT, PHYSICAL and MENTAL CONDITIONS

Environment

Work is performed primarily in a standard office environment. with extensive employee contact and frequent interruptions. Work may be approved by the Quality/Compliance Development Manager at a minimum of one time per work week to be conducted remotely depending on assigned workload and coverage needs of the office. Work may also be required outside the office or remote environment in relation to needs of the organization. This can include overnight travel. Exposure to outside weather conditions will exist. The noise level in the work environment is between low to moderate.

Physical

Primary functions require sufficient physical ability and mobility to work in an office setting, to stand or sit for prolonged periods of time; to occasionally stoop, bend, kneel, crouch, reach and twist; to lift and carry light to moderate (15 pounds) amounts of weight, to operate office equipment requiring repetitive hand movement and fine coordination including use of a computer keyboard; to travel to other locations using various modes of private and commercial transportation; and to verbally communicate to exchange information. Requires the ability to see, within the normal vision range, with or without correction. Requires the ability to hear, within the normal audio range, with or without correction.

Mental

Work responsibilities will require excellent problem-solving skills and organizational skills. Will be exposed to situations which are urgent or emergent, which may require immediate action. Responsibilities require multi-tasking, with extensive employee contact and frequent interruptions, which could be time sensitive and/or have deadlines. Will require management of requests and situations that occur at the same time.

Position Funding: This position’s funding is determined by WCSI’s allocation process. Incumbent in this position may be required to complete a WCSI Time Study, frequency determined by Fiscal Management, for purposes of this allocation process.

REASONABLE ACCOMODATION

It is WCSI’s business philosophy and practice to provide reasonable accommodations, according to applicable state and federal laws, to all qualified individuals with disabilities.