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QUALITY MANAGEMENT III

Company: Beacon Health Options
Location: Colorado Springs
Posted on: September 13, 2020

Job Description:

We Help People Live their Lives to the Fullest Potential!

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a'world-class' candidate experience from the moment you click'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

Do you have a passion for helping others? If so, we are looking for you!

Beacon is currently seeking a Clinical Quality Specialist III to join our team out of Colorado Springs, CO. The Clinical Quality Specialist III is a professional level position that supports clinical quality management functions and implements contractual requirements such as auditing and practice transformation. This position will participate in a range of quality management activities, including planning, implementation, monitoring, training, and reporting. This position is responsible for providing leadership and coordination of clinical, quality and provider-related quality activities, including provider record review process, performance/quality improvement projects including practice transformation program, quality of care issues and the provider monitoring program. Extensive in-state travel up to 30% with overnight stays is required.

What does a typical day look like?


  • Conduct contract-required quality reviews to ensure compliance with policies, state and federal standards and client performance standards and participate in other monitoring assignments as required (i.e. practice transformation, APM measure audits).
  • Work with Clinical, Provider Relations and QM Departments to establish and maintain processes for regular treatment record reviews (mental health, substance use, hospital, residential, care coordination and others as assigned).
  • Conduct contractual audits (Care Coordination, Practice Transformation), treatment record audits; and compile and report results. Audits may occur at provider offices or facilities or virtually.
  • Identify trends and patterns of deficiencies within practices, evaluate results, identify and communicate areas for improvement
  • Coordinate and communicate provider monitoring and improvement activities and results. Provide feedback letters, initiate corrective actions and monitor as specified in policy.
  • Identify specific areas of focus for treatment record audits and provider training/education annually; evaluate results, identify, and communicate areas for improvement within the system. Coordinate the claims recoupment process for behavioral health and substance use services as assigned, based on audit results and policy guidelines.
  • Coordinate and communicate provider monitoring, improvement and education activities and results within the QM Department, inter-departmentally, and externally; distribute/communicate to client and provider organizations as specified. Monitor corrective action plans for improvement. Participate in provider monitoring formal feedback efforts. Initiate and/or plan and participate in the annual contract compliance audits/site visits as directed.
  • Conduct and track adverse incident and quality of care issue investigations as needed; attend associated meetings and training.
  • Co-chair or lead assigned meetings; participate in State, client and provider/facility meetings and performance improvement and practice transformation initiatives (PIPs, behavioral health, KPI measures) as directed.
  • Work with Quality Manager to coordinate the annual encounter/claims audit.
  • Conduct other routine QM Department tasks, including ensuring assigned areas of responsibility comply with contract, and State requirements; preparation of documents for External Quality Review, delegation or other site visits.


    What you Contribute?

    Education: RN (preferred) Master's degree in clinical specialty; substance use treatment experience preferred.

    License: Licensure is preferred: RN, LCSW, LPC, LMFT, or PhD are acceptable

    Knowledge, Skills& Abilities: Two years of direct treatment experience is required and at least one year experience in Quality Management, auditing, or managed care; behavioral health background/licensure or RN preferred.

    What Makes Us Different?

    • Here, it's not just a job- it's an opportunity to change lives.
    • Our employees are learners, innovators and original thinkers.
    • Our mission and values guide the way we treat our members, providers and each other.

      What We Have to Offer:

      • Healthcare benefits available starting day 1!
      • Health& wellbeing incentives, such as gym membership reimbursement
      • 401K with company match to help reach your future financial goals
      • Generous PTO, because we know life happens outside of work

        If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

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

        Beacon Health Options company, is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

        At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

        #GD

        PM16

        #LI

Keywords: Beacon Health Options, Colorado Springs , QUALITY MANAGEMENT III, Executive , Colorado Springs, Colorado

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