Quality Assurance Administrator in Remote, Georgia at COLUMBUS MEDICAL SERVICES LLC

The Columbus Organization is a group of caring professionals whose mission is to assist individuals at risk and with complex care needs remain in the least restrictive environment of their choice while improving their quality of life through coordinated services and supports. With a person-centered planning & thinking approach, it is our vision to be recognized as an organization that transforms individuals’ lives and provides families the peace of mind in knowing their loved one has a voice and a valued role in their community.

The Quality Assurance Administrator (QAA) is responsible for overseeing, monitoring, and ensuring the quality of Case Management services in compliance with federal Medicaid regulations, state policies, and contractual requirements.

This role ensures quality through auditing, data analysis, corrective action management, participant and family engagement, and continuous quality improvement initiatives. The QAA provides direct oversight of service documentation, performance audits, participant satisfaction efforts, complaint resolution, and the development and monitoring of corrective action plans.

The QAA collaborates closely with program leadership, supervisors, and frontline teams to identify risks, address deficiencies, and strengthen overall service delivery.

1. Quality Assurance Oversight

1. Oversee and implement the agency’s Quality Assurance and Continuous Quality Improvement (CQI) program for care coordination services.

1. Conduct routine reviews of support plans and/or electronic case records using approved tools to verify completeness, documentation integrity, clinical appropriateness, and regulatory compliance.

1. Coaches Field Care Coordinators directly on documentation gaps.

1. Submits finalized support plans to state agencies, in applicable markets.

1. Monitor adherence to contractual deliverables, service timelines, and mandated documentation requirements.

1. Data Analysis & Reporting

1. Analyze quality and performance data to identify trends, risks, deficiencies, training gaps, and areas for improvement.

1. Prepare and monthly, quarterly, and/or ad‑hoc quality assurance reports, including required summaries to applicable states.

1. Support state and federal audits, record reviews, and administrative monitoring activities.

1. Corrective Action & Quality Improvement

1. Monitor and evaluate the effectiveness of corrective action plans in response to:

1. Partner with supervisors and leadership to strengthen service outcomes.

1. Participant & Family Engagement

1. Directly contact service recipients, families, and/or guardians when appropriate to:

1. Oversee the complaint process, including intake, investigation, resolution, documentation, and trend analysis.

1. Ensure participants are informed of complaint and grievance procedures in alignment with organizational, state and/or federal regulations.

1. Identify needed improvements based on survey results and monitor implementation.

1. Collaboration & Program Support

1. Work in partnership with supervisors, program leadership, and training staff to support effective case management operations.

1. Provide guidance and QA consultation to supervisors and leadership as needed.

1. Participate in the review and revision of quality assurance processes annually or as needed.

1. Communicate trends, risks, findings, and recommendations leadership at least monthly.

1. Administrative Responsibilities

1. Assist with program oversight related to quality and staff competency.

1. Participate in planning, implementation, and coordination to ensure alignment with federal, state, and organizational requirements.

1. Maintain accurate QA documentation and records in accordance with confidentiality and HIPAA requirements.

1. Complete all required annual and assigned training.

1. Bachelor’s degree from an accredited institution in Human Services, Behavioral Sciences, Social Sciences, or a related field. In lieu of a degree, four (4) or more years of experience in a relevant field may be considered.

1. Minimum of three (3) years of experience in quality assurance, compliance monitoring, auditing, or quality improvement within healthcare, Medicaid, HCBS, or developmental disabilities services.

1. Experience in case management or developmental disabilities services strongly preferred.

1. (Education or experience requirements may be waived where permitted by states based on demonstrated capability.)

1. Knowledge of Medicaid, HCBS, and state policies and regulations.

1. Strong analytical skills with the ability to identify trends and develop clear reports.

1. Experience developing and monitoring corrective action and quality improvement plans.

1. Proficiency in Microsoft Office 365 and electronic record systems.

1. Excellent written and verbal communication skills.

1. Strong attention to detail, accountability, and ability to work independently.

1. Ability to engage professionally with participants, families, and multidisciplinary teams.

1. Strong organizational skills with the ability to prioritize and meet deadlines.

The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.

The Columbus Organization provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, The Columbus Organization complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

The Columbus Organization expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of The Columbus Organization’s employees to perform their job duties may result in discipline up to and including discharge.