STATE OF NEW HAMPSHIRE
CLASSIFICATION: QUALITY CONTROL REVIEWER
Class Code: 7405-20 Date Established: 09-12-66
Occupational Code: 7-7-7 Date of Last Revision: 11-08-06
BASIC PURPOSE: To investigate and review public and provider programs to ensure compliance with program standards and to make recommendations for improvements or changes in program procedures.
CHARACTERISTIC DUTIES AND RESPONSIBILITIES:
· Interviews providers or recipients for the purpose of verifying information found in case records.
· Participates in the development and maintenance of a system of reviews utilizing regulatory agency standards, objectives and goals as evaluation tools.
· Conducts detailed review and analysis of randomly selected clientele and audits payment cases, including open and closed records.
· Reviews federal and state regulations and policies and applies them to cases being reviewed.
· Prepares reports of program activities for review by supervisors and federal officials.
· Conducts investigations through state agencies, employers and various financial and insurance agencies to verify any other information relevant to a particular case's eligibility history.
Skill: Requires skill in developing formats and procedures for special applications OR in investigating and reviewing the use of equipment and data for a specialized function.
Knowledge: Requires logical or scientific understanding to analyze problems of a specialized or professional nature in a particular field.
Impact: Requires responsibility for contributing to immediate, ongoing agency objectives by facilitating the direct provision of services to the public or other state agencies. Errors at this level result in inaccurate reports or invalid test results and require significant investment of time and resources to detect.
Supervision: Requires direct supervision of other employees doing work which is related or similar to the supervisor, including scheduling work, recommending leave, reviewing work for accuracy, performance appraisal, or interviewing applicants for position vacancies.
Working Conditions: Requires performing regular job functions in a controlled environment with minimal exposure to disagreeable job elements and little risk of hazard to physical or mental health.
Physical Demands: Requires light work, including continuous walking or operating simple equipment for extended periods of time as well as occasional strenuous activities such as reaching or bending.
Communication: Requires summarizing data, preparing reports and making recommendations based on findings which contribute to solving problems and achieving work objectives. This level also requires presenting information for use by administrative-level managers in making decisions.
Complexity: Requires coordinating a combination of diverse job functions in order to integrate professional and technical agency goals. This level also requires considerable judgment to implement a sequence of operations or actions.
Independent Action: Requires a range of choice in applying a number of technical or administrative policies under general direction and in making routine decisions or in recommending modifications in work procedures for approval by supervisor.
Education: Bachelor's degree from a recognized college or university with a major study in one of the liberal arts or a field related to business administration. Each additional year of approved formal education may be substituted for one year of required work experience.
Experience: Three years' experience at a level equivalent to a Family Service Specialist or Case Technician, with responsibility for review of operations, conducting investigations, program auditing, or quality control. Each additional year of approved work experience may be substituted for one year of required formal education.
License/Certification: Eligibility for New Hampshire driver's license.
For appointment consideration, Quality Control Investigator applicants must successfully participate in a structured interview measuring possession of knowledge, skills and abilities identified as necessary for satisfactory job performance by this class specification. The structured interview is developed and administered, according to Division of Personnel guidelines, by representatives of the state agency in which the vacancy exists.
RECOMMENDED WORK TRAITS: Extensive knowledge of the administration, operation, methods and materials relating to the program to which assigned. Considerable knowledge of investigative techniques. Working knowledge of planning and procedures necessary for specific program operations. Ability to plan and organize work activities and to determine materials, space, equipment and personnel necessary to accomplish goals and objectives. Ability to work with and secure the cooperation of others. Ability to communicate effectively. Ability to establish and maintain effective working relationships with program administrators, public officials and clientele. Must be willing to maintain appearance appropriate to assigned duties and responsibilities as determined by the agency appointing authority.
DISCLAIMER STATEMENT: This class specification is descriptive of general duties and is not intended to list every specific function of this class title.
Last Updated 10/21/04