QUALITY MGMT SPEC II

Location
AR: Little Rock

Job Family
Quality Mgmt / Performance Improvement


Job Brief

The Quality Management Specialist II will be responsible for providing critical evaluation and monitoring of clinical and quality process improvements to meet NCQA, HEDIS® monitoring and reporting requirements

ABOUT THE POSITION

We are currently seeking a dynamic Quality Management Specialist II to join our team at our office in Little Rock, AR. The Quality Management Specialist II will be responsible for providing critical evaluation and monitoring of clinical and quality process improvements to meet NCQA, HEDIS® monitoring and reporting requirements

Positions Responsibilities

• Coordinates and manages key aspects ofcontractual requirements, accreditation (NCQA, URAC) and other regulatory requirements including but not limited to:
  
  1. knowledge of the standards
  2. working with the team to meet or/ & exceed the standards and
  3. regulatory requirements
  4. maintenance of necessary and relevant documentation history
  5. completion of accreditation documentation requirements
• Conduct audits/internal assessments of clinical and operational activities to ensure compliance with corporate policies, quality management activities and accreditation standards.
• Manages complaint, quality of care, adverse incident reporting and investigation process to ensure compliance with corporate policies, client, regulatory and accreditation standards.
• Serves as a liaison to Health Plan clients related to complaints, quality of care, adverse incidents
• Provide ongoing support for accreditation survey preparation.
• Serves as an internal consultant for service center-wide performance improvement activitiesand reporting of complaints, quality of care, adverse and critical incidents including:
  
  1. coordination of QIAs, surveys, research and other supporting functions
  2. consultation to clinical and customer service staff as well as assistance with training
  3. working with Clinical staff as additional resources for clinical review
  4. reviews and makes changes as required for relevant policies, procedures and workflows
  5. role model for QM principles and practices
• Participates in internal and external Quality Management Committees or Workgroup activities.
• Provides documentation, monitoring and analysis for various QM and review activities including but not limited to:
  
  1. Quality of Care Cases
  2. Adverse Incidents
  3. Treatment Record Review
  4. Access and availability
• Works closely with Clinical Operations, Customer Service, Account Management and Provider Relations at a local level to ensure comprehensive, efficiency and integrated systems that ensure communication and positive outcomes.
• Performs other duties as assigned.

Master's Degree required in one of the following related fields: QM, Psychology, Behavioral Health, Statistics or RN with relevant QM or Managed Care Experience.

Licensure: Clinical License (LMHC, LMFT, RN, LCSW etc.) preferred but not required.

Relevant Work Experience:

• 3 years' experience in Quality Management (QM) or Utilization Management (UM) required. 5 years' experience in QM & UM if not licensed.

:

• Great analytical skills
• Excellent verbal and written communication skills
• Managed care experience

Click below on "Apply for this Position" to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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AAP Reporting Location:

AR - Little Rock

ID (Req #):

56770

FTE Status:

Full Time

Schedule:

Monday-Friday 8:30a-5:00pm

Exempt