Quality Assurance Risk Management Coordinator

Step into a role where your careful thinking can spark real progress!

As a Quality Assurance Risk Management Coordinator for the Department of Human Services, you will evaluate programs and help improve the quality of behavioral health services.

You will work with partners who share a commitment to strong, reliable care.

Your contributions will lead to better results for communities across the state.

Step into a role where your careful thinking can spark real progress!

As a Quality Assurance Risk Management Coordinator for the Department of Human Services, you will evaluate programs and help improve the quality of behavioral health services.

You will work with partners who share a commitment to strong, reliable care.

Your contributions will lead to better results for communities across the state.

This position supports the improvement of behavioral health services by reviewing information, evaluating program performance, and working with partners across the Commonwealth. As a Quality Assurance Risk Management Coordinator, you will perform the following duties: Program Reviews: Examine contractor and managed care operations for compliance with federal and state rules Data Evaluation: Assess documents and reports to determine if standards, goals, and benchmarks are met Compliance Monitoring: Review service decisions and related documentation for clarity and adherence to medical necessity requirements Onsite Audits: Lead audits and interviews to evaluate access, quality, and risk in behavioral health services Collaboration Efforts: Work with internal and external partners on quality reviews and clinical best practices Policy Analysis: Study legislative and regulatory changes and interpret their impact on behavioral health services Interested in learning more? Additional details regarding this position can be found in the position description . Work Schedule and Additional Information: Full-time employment 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, up to 3 days per week. 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. The ability to telework is subject to change at any time. Additional details may be provided during the interview.

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.

This position supports the improvement of behavioral health services by reviewing information, evaluating program performance, and working with partners across the Commonwealth.

As a Quality Assurance Risk Management Coordinator, you will perform the following duties:

• Program Reviews: Examine contractor and managed care operations for compliance with federal and state rules
• Data Evaluation: Assess documents and reports to determine if standards, goals, and benchmarks are met
• Compliance Monitoring: Review service decisions and related documentation for clarity and adherence to medical necessity requirements
• Onsite Audits: Lead audits and interviews to evaluate access, quality, and risk in behavioral health services
• Collaboration Efforts: Work with internal and external partners on quality reviews and clinical best practices
• Policy Analysis: Study legislative and regulatory changes and interpret their impact on behavioral health services

Interested in learning more?

Additional details regarding this position can be found in the position description .

• Full-time employment
• 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, up to 3 days per week. 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. The ability to telework is subject to change at any time. Additional details may be provided during the interview.
• 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.

QUALIFICATIONS Minimum Experience and Training Requirements: One year as a Quality Assurance/Risk Management Specialist; 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 Guidelines. You must be able to perform essential job functions. This position is not subject to the provisions of a collective bargaining agreement or memorandum of understanding. You must be eligible for selection in accordance with merit system employment regulations. Recruitment Methods: Applicants must meet one of the following methods to be considered for this vacancy: Promotion Without Exam Reassignment ( Only current civil service employees in the same agency who hold the same or similar job title, with the same maximum salary, within the same occupational group or where there is a logical career movement, will qualify for reassignment .) Transfer ( Only current civil service employees who hold the same job title will qualify for transfer to another agency.) Voluntary Demotion Reinstatement ( Former civil service employees may only be reinstated to the job title from which they resigned. Current civil service employees are not eligible through reinstatement. ) Promotion Without Examination (PWOE): Class Restrictions for Promotion Without Examination Only - You must have or have held regular civil service status in one of the following classifications: Quality Assurance/Risk Management Specialist Social Worker 2 Forensic Social Worker 2 Employees who previously held regular civil service status in the job title of the position being filled are also eligible for promotion without examination. The promotion without examination requirements are issued in accordance with merit system employment regulations. Meritorious service is defined as (a) the absence of any discipline above the level of written reprimand during the 12 months preceding the closing date of the posting, and (b) the last regular or probationary performance evaluation showing an overall rating of satisfactory or higher. Applicants must have a minimum of one year in the next lower classes by the posting closing date with no break in service.

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.

All application materials and interview responses must reflect the applicant’s own experience, qualifications, and work.

Applicants may use generative AI tools for preparation purposes only.

Use of AI to misrepresent or falsify information, or to assist during interviews, is not permitted.

Review the Guidance for Generative AI Tools & Job Seekers for additional information.

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.

• One year as a Quality Assurance/Risk Management Specialist; 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.

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

This position is not subject to the provisions of a collective bargaining agreement or memorandum of understanding.

You must be eligible for selection in accordance with merit system employment regulations.

• Applicants must meet one of the following methods to be considered for this vacancy: Promotion Without Exam Reassignment ( Only current civil service employees in the same agency who hold the same or similar job title, with the same maximum salary, within the same occupational group or where there is a logical career movement, will qualify for reassignment .) Transfer ( Only current civil service employees who hold the same job title will qualify for transfer to another agency.) Voluntary Demotion Reinstatement ( Former civil service employees may only be reinstated to the job title from which they resigned. Current civil service employees are not eligible through reinstatement. )

• Reassignment ( Only current civil service employees in the same agency who hold the same or similar job title, with the same maximum salary, within the same occupational group or where there is a logical career movement, will qualify for reassignment .)
• Transfer ( Only current civil service employees who hold the same job title will qualify for transfer to another agency.)
• Voluntary Demotion
• Reinstatement ( Former civil service employees may only be reinstated to the job title from which they resigned. Current civil service employees are not eligible through reinstatement. )

• Class Restrictions for Promotion Without Examination Only - You must have or have held regular civil service status in one of the following classifications: Quality Assurance/Risk Management Specialist Social Worker 2 Forensic Social Worker 2

• Employees who previously held regular civil service status in the job title of the position being filled are also eligible for promotion without examination.
• The promotion without examination requirements are issued in accordance with merit system employment regulations.
• Meritorious service is defined as (a) the absence of any discipline above the level of written reprimand during the 12 months preceding the closing date of the posting, and (b) the last regular or probationary performance evaluation showing an overall rating of satisfactory or higher.
• Applicants must have a minimum of one year in the next lower classes by the posting closing date with no break in service.

• 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.
• All application materials and interview responses must reflect the applicant’s own experience, qualifications, and work. Applicants may use generative AI tools for preparation purposes only. Use of AI to misrepresent or falsify information, or to assist during interviews, is not permitted. Review the Guidance for Generative AI Tools & Job Seekers for additional information.

• 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.

Learn more about our Total Rewards by watching this short video ! See the total value of your benefits package by exploring our benefits calculator . 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.* Compensation & Financial Planning 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. Employee Perks Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships. For more information on all of these Total Rewards benefits, please visit www.employment.pa.gov and click on the benefits box. *Eligibility rules apply.

Learn more about our Total Rewards by watching this short video !

See the total value of your benefits package by exploring our benefits calculator .

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.*

• Yes
• No
• 3 years or more
• 2 but less than 3 years
• 1 but less than 2 years
• Less than 1 year
• None
• 3 years or more
• 2 but less than 3 years
• 1 but less than 2 years
• Less than 1 year
• None
• Yes
• No
• 30 or more credits
• Less than 30 credits
• None