Quality Specialist in Fond du Lac, Wisconsin at Lakeland Care Incorporated

Join our award winning culture as we serve members in your area!

Under the general direction of the Quality Risk Manager, this position serves as a subject matter expert ensuring Lakeland Care, Inc.’s (LCI) member incident reporting and Adult Incident Reporting System (AIRS) requirements are met. The Quality Specialist provides support to Care Management Supervisors and Interdisciplinary Team Staff (IDTS) on matters related to member incidents, quality of care provided to members, risk mitigation, and adherence to policies, procedures and processes. The Quality Specialist also collaborates closely with Provider Relations Department staff to maintain a network of providers that deliver high quality services.

• Monitor AIRS, the Incident Management System (IMS), to promptly review and respond to incidents and notifications reported by IDTS.
• Participate in External Quality Review activities related to IMS, member risk, member rights, and appeal and grievance systems.
• Provide support to Care Management in strategies to mitigate imminent risk for the membership.
• Collaborate with Provider Quality Team to investigate and address provider quality of care issues to support member health and safety.
• Timely and accurately submit incidents/notifications to the Department of Health Services (DHS) via AIRS - investigate all incidents to determine facts, root cause, outcome, preventative strategies; and close all incidents.
• Provide technical assistance to LCI staff on topics related to member incident reporting and AIRS.
• Exhibit maturity, resiliency, and sound judgement when dealing with organizational challenges, emotional situations, multiple deadlines, and conflict.
• Embrace growth mindset and respond constructively to feedback
• Collaborate with Care Management and Provider Quality staff to support identification of prevention and remediation strategies to reduce member risk and address provider-related concerns.
• Serve as a member of LCI’s Appeal and Grievance Committee and interface with local and/or state advocacy agencies as needed.
• Mission and values guide actions and interactions.
• Utilize policies, procedures, and processes in decision making and to complete associated responsibilities.

• Bachelor’s degree in social work, nursing, special education, rehabilitation or related human services field, or equivalent combination of formal education and experience.
• Minimum of three (3) years of experience with at least one (1) years' experience in risk-related work experience.
• Must possess intermediate skills with Microsoft Office Suite, particularly Word, PowerPoint, Excel, and Outlook.
• Knowledge of the nature and appropriate services for the treatment and care of physical disabilities, disabilities due to advanced age, and intellectual/developmental disabilities.
• Knowledge of member rights and appeal and grievance systems.
• Able to build and motivate teams with demonstrated leadership and facilitation experience.
• Effective written and oral communication skills.
• Ability to professionally and objectively review and discuss member events.
• Able to prioritize, organize and carry out work assignments independently and efficiently.
• Current driver's license, acceptable driving record and proof of adequate insurance required.
• Knowledge of the Wisconsin Family Care Program and managed care principles.
• Knowledge of Chapters 51, 55, 880 procedures and requirements related to member rights.
• Familiarity with documentation and reporting in an EMR.