QUALITY MANAGEMENT III
Company: Beacon Health Options
Location: Colorado Springs
Posted on: September 13, 2020
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
Do you have a passion for helping others? If so, we are looking for
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
- Identify trends and patterns of deficiencies within practices,
evaluate results, identify and communicate areas for
- 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
- 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
- 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
- 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
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
- Our employees are learners, innovators and original
- 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
- 401K with company match to help reach your future financial
- 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.
Keywords: Beacon Health Options, Colorado Springs , QUALITY MANAGEMENT III, Executive , Colorado Springs, Colorado
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