Quality Assurance Risk Management Coordinator

Salary: $66,250.00 - $100,636.00 Annually
Location : Dauphin County, PA
Job Type: Civil Service Permanent Full-Time
Job Number: CS-2025-22434-43392
Department: Department of Human Services
Division: HS Bur Qlty Mgmt Dta Rvw
Opening Date: 04/03/2025
Closing Date: 4/17/2025 11:59 PM Eastern
Job Code: 43392
Position Number: 00297271
Union: Non-Union
Bargaining Unit: A3
Pay Group: ST08
Bureau / Division Code: 00211550
Bureau / Division: Bureau of Quality Management and Data Review
Worksite Address: 303 Walnut Street
City: Harrisburg, Pennsylvania
Zip Code: 17101
Contact Name: Chavonte' Hunter
Contact Phone: 717.257.7889
Contact Email: chahunter@pa.gov

THE POSITION

Are you a passionate and committed professional with a strong desire to ensure high-quality behavioral health services are delivered to Pennsylvania residents? The Department of Human Services is seeking an exceptional Quality Assurance Risk Management Coordinator to join our Division of Quality Management team. In this pivotal role, you will play a key part in advancing the Commonwealth's efforts to continuously monitor, assess, and enhance the accessibility and quality of health services offered. If you are ready to elevate your career and take on a fulfilling new challenge, this is the perfect opportunity for you!
DESCRIPTION OF WORK

This management-level position involves synthesizing data from various sources to assess compliance and identify risks related to Medicaid Behavioral HealthChoices standards for Managed Care Organizations (MCOs) and individual primary contractors. In this role, you will oversee and monitor Pennsylvania's Behavioral Health Choices program, conducting annual compliance reviews and on-site evaluations every three years for behavioral health managed care organizations in the state to ensure compliance with state and federal regulations. The position also includes reviewing MCO quality management program descriptions, work plans, annual evaluations, provider profiles, and policies and procedures. Additionally, you will assess service denial letters, member complaints, and performance measure outcomes to ensure they meet department contract requirements. As a key team member, you will provide expert guidance in analyzing and interpreting new and existing regulations, policies, procedures, standards, and clinical guidelines, ensuring the high-quality delivery of behavioral health services while offering targeted technical assistance to various business partners.
Interested in learning more? Additional details regarding this position can be found in the position description.
Work Schedule and Additional Information:

• Full-time employment, 37.5 hours per week
• Work hours are 8:00 AM to 4:30 PM, Monday - Friday, with a 60-minute lunch.
• Telework: You may have the opportunity to work from home (telework) part-time with a minimum of one day per month in the office or as required. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
• Salary: In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY
QUALIFICATIONS

Minimum Experience and Training Requirements:

• One year as a Quality Assurance/Risk Management Specialist (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration); or
• Three years of professional experience as a member of a multiple disciplinary treatment team in a public or private health care facility and a bachelor's degree; or
• Three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work in a health care program; and a bachelor's degree with major course work in social work, nursing, health care administration, behavioral sciences or a related field; or
• Any equivalent combination of experience and training.

Other Requirements:

• You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency.
• You must be able to perform essential job functions.

How to Apply:

• Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
• Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
• Failure to comply with the above application requirements may eliminate you from consideration for this position.

Veterans:

• Pennsylvania law (51 Pa. C.S. 7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans' Preference tab or contact us at ra-cs-vetpreference@pa.gov.

Telecommunications Relay Service (TRS):

• 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.
The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

EXAMINATION INFORMATION

• Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
• Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
• Your score is valid for this specific posting only.
• You must provide complete and accurate information or:
  • your score may be lower than deserved.
  • you may be disqualified.
• You may only apply/test once for this posting.
• Your results will be provided via email.

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Health & Wellness

We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*

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We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.

Work/Life Balance
We know there's more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*

Values and Culture
We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.

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*Eligibility rules apply.
01

Have you been employed by the Commonwealth of Pennsylvania as a Quality Assurance/Risk Management Specialist for one or more years full-time?

• Yes
• No

02

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.
03

How many years of full-time professional experience as a member of a multiple disciplinary treatment team in a public or private health care facility do you possess?

• 3 years or more
• 2 but less than 3 years
• 1 but less than 2 years
• Less than 1 year
• None

04

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.
05

How many years of full-time clinical experience in a human services agency do you possess?

• 3 years or more
• 2 but less than 3 years
• 1 but less than 2 years
• Less than 1 year
• None

06

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.
07

Do you possess two or more years of full-time administrative, evaluative, consultative clinical experience or supervisory work in a health care program?

• Yes
• No

08

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.
09

How much graduate coursework have you completed in social work, nursing, health care administration, behavioral sciences, or a related field?
If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted.

If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visiting and clicking the Evaluation Services Link.

For additional information on foreign education credentials, please visit and click on Other Information. You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted.

• 30 credits or more
• Less than 30 credits
• None

10

You must complete the supplemental questions below. These supplemental questions are the exam and will be scored. They are designed to give you the opportunity to relate your experience and training background to the major activities (Work Behaviors) performed in this position. Failure to provide complete and accurate information may delay the processing of your application or result in a lower-than-deserved score or disqualification. You must complete the application and answer the supplemental questions. Resumes, cover letters, and similar documents will not be reviewed for the purposes of determining your eligibility for the position or to determine your score.
All information you provide on your application and supplemental questions is subject to verification. Any misrepresentation, falsification or omission of material facts is subject to penalty. If requested, you must provide documentation, including names, addresses, and telephone numbers of individuals who can verify the validity of the information you provide in the application and supplemental questions.

Read each question carefully. Determine and select which "Level of Performance" most closely represents your highest level of experience/training. List the employer(s)/training source(s) from your Work or Education sections of the application where you gained this experience/training. The "Level of Performance" you choose must be clearly supported within the description of the experience and training information entered in your application or your score may be lowered. In order to receive credit for experience, you must have worked in a job for at least six months in which the experience claimed was a major function.

If you have read and understand these instructions, please click on the "Yes" button and proceed to the exam questions.

If you have general questions regarding the application and hiring process, please refer to our

• Yes

11

WORK BEHAVIOR 1 - DEVELOPS/IMPLEMENTS QUALITY MANAGEMENT/PERFORMANCE IMPROVEMENT PLANS

Develops and implements quality management and performance improvement plans and direct-action plans. Establishes priorities and ensures compliance by reading and interpreting related federal, state, and accrediting agencies' rules, regulations, policies, and procedures. Educates staff on new or changing requirements and provides data to interested parties as necessary.

Levels of Performance
Select the Level of Performance that best describes your claim.

• A. I have experience developing and implementing quality management and performance improvement plans or direct-action plans. I was responsible for ensuring compliance with established rules, regulations, policies, and procedures.
• B. I have experience implementing quality management and performance improvement plans or direct-action plans that were developed by someone else. I was responsible for ensuring compliance with established rules, regulations, policies, and procedures.
• C. I have successfully completed college-level coursework related to strategic or program planning.
• D. I have NO experience or training related to this work behavior.

12

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

The name(s) of the employer(s) where you gained this experience.

The actual duties you performed related to developing/implementing quality management/performance plans.

The type(s) of quality management/performance plans you developed/implemented.

Your level of responsibility.

13

If you have selected the level of performance pertaining to college coursework, please provide your responses to the three items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

College/University

Course Title

Credits/Clock Hours

14

WORK BEHAVIOR 2 - EVALUATES QUALITY MANAGEMENT/PERFORMANCE IMPROVEMENT PLANS

Analyzes incident and other related performance indicator data utilizing available sources such as electronic data base systems, software, reports, literature, questionnaires, and charts for the purpose of establishing baseline performance and determining areas in need of quality improvement and/or risk mitigation.

Levels of Performance
Select the Level of Performance that best describes your claim.

• A. I have experience analyzing incident and other related data to establish baseline performance and determine areas in need of improvement and/or risk mitigation. I was responsible for providing recommendations for changes.
• B. I have experience analyzing incident and other related data to establish baseline performance and determine areas in need of improvement and/or risk mitigation. I did NOT provide recommendations for changes.
• C. I have successfully completed college-level coursework related to program evaluation.
• D. I have NO experience or training related to this work behavior.

15

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

The name(s) of the employer(s) where you gained this experience.

The type(s) of incident and performance data you analyzed.

The recommendations you provided.

The actual duties you performed.

Your level of responsibility.

16

If you have selected the level of performance pertaining to college coursework, please provide your responses to the three items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

College/University

Course Title

Credits/Clock Hours

17

WORK BEHAVIOR 3 - DEVELOPS AND IMPLEMENTS EVALUATION SYSTEMS/TOOLS

Develops and implements systems/tools to monitor quality assurance or risk management plans. Interviews staff and individuals served and utilizes other acceptable evaluation tools, such as audit reports and quality assurance checklists, to review and monitor program operations. Areas of focus may include risk/incident management plans, focus group work plans, policies, procedures, and completion timetables for quality assurance/risk management activities implemented by other departments.

Levels of Performance
Select the Level of Performance that best describes your claim.

• A. I have experience developing AND implementing systems/tools to monitor quality assurance or risk management plans. I was responsible for ensuring the plans stay on task and within the proposed timeline.
• B. I have experience implementing systems/tools to monitor quality assurance or risk management plans that were developed by someone else. I was responsible for ensuring the plans stay on task and within the proposed timeline.
• C. I have experience utilizing systems/tools to monitor quality assurance or risk management plans.
• D. I have successfully completed college-level coursework related to quality assurance or risk management.
• E. I have NO experience or training related to this work behavior.

18

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

The name(s) of the employer(s) where you gained this experience.

The actual duties you performed related to developing, implementing, or utilizing evaluation systems or tools.

Your level of responsibility.

19

If you have selected the level of performance pertaining to college coursework, please provide your responses to the three items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

College/University

Course Title

Credits/Clock Hours

20

WORK BEHAVIOR 4 - PROVIDES GUIDANCE AND TECHNICAL ASSISTANCE

Provides guidance, technical assistance, and training to system improvement teams by utilizing available performance improvement data to demonstrate known performance improvement practices such as root cause analysis, proactive risk assessment, plan-do-check-act activities, and other known quality management methodologies used to develop, implement, and/or monitor action plans and services to minimize risk, correct deficiencies, and improve quality.

Levels of Performance

Select the Level of Performance that best describes your claim.

• A. I have conducted presentations to provide information and demonstrations on performance improvement practices and other known quality management methodologies to minimize risk, correct deficiencies, and improve quality.
• B. I have responded to inquiries regarding performance improvement practices and other known quality management methodologies to minimize risk, correct deficiencies, and improve quality.
• C. I have successfully completed college-level coursework related to training or public speaking.
• D. I have NO experience or training related to this work behavior.

21

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

The name(s) of the employer(s) where you gained this experience.

The subject matter of the presentations you provided.

The audience to whom you presented.

The types of inquiries to which you responded.

The actual duties you performed.

22

If you have selected the level of performance pertaining to college coursework, please provide your responses to the three items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

College/University

Course Title

Credits/Clock Hours

Required Question