Manager Quality in Cypress, CA at Beacon Health Options

Date Posted: 8/8/2019

Job Snapshot

Job Description

ABOUT THE POSITION 

We are currently seeking a dynamic Manager, Quality. The Manager of Quality works directly with the AVP, Regional Quality and Beacon staff to oversee the effective implementation of quality improvement activities, analysis, and reporting of key quality indicators, and ensuring the Regions are compliant with NCQA and URAC accreditation standards as well as contractual and regulatory requirements that impact Quality programs and activities.

Position Responsibilities:

1.     As directed by the AVP, oversee of daily clinical/ quality operations. Daily operations include overseeing the following processes: processing of VOC grievances, real time VOC grievance audits, adverse incidents, quality of care, potential quality issues, and subpoena requests.

2.     Oversight of the provider chart review process, responsible for requesting, scoring, and communicating provider results in internal and external forums.

3.     Responsible for responding to client audits, client corrective action plans, and implementations.

4.     Active participation in client Joint Operations Meetings and Regional/Corporate Quality Improvement Activities (QIAs) teams. Understand the various Health Plan and MHSA/EAP member population and implement activities accordingly to improve quality of care and service to members.

5.     Oversee review of all quality of care, adverse incidents and grievances to assess for potential quality of care issues.

6.     Responsible for assuring that Beacon remains in compliance with NCQA and URAC standards pertaining to quality operations.

7.     Assist in NCQA and URAC desktop audit through coordination with other departments, evidence gathering, and, annotation and submission through NCQA/URAC web portal.

8.     Will act as a primary chairperson for a variety of clinical quality committees including, quality of care committees, credentialing committees, provider review committee, and provider advisory council.

9.     Assist in all areas of quality improvement throughout Beacon, including preparing and presenting staff trainings on issues related to Quality as part of Beacon’s Employee training program requirements.

10.  Serve as the lead for Cultural and Linguistic (C&L) Program which will include development and implementation of the C&L work plan.

11.  Update the program description annually as necessary.

12.  Develop literature and educational materials for members and providers. Gather training materials for staff. Responsible for updating and managing quality policies and procedures.

13.  Coordinate directly with translation/interpreter vendor to provide translation/interpretation services.

14.  Adheres to all Beacon policies and procedures and standards of operations.

15.  Completes all required and assigned trainings.

16.  Performs annual staff reviews and establish individual/team goals for development.

17.  Motivates team members to reach department goals and objectives.

18.  Attends all mandatory company or department meetings.

19.  Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

20.  Acts as a mentor to team members by leading by example and guiding with a sense of integrity and team work.

21.  Meets regularly with team members for one on ones and staff meetings.

22.  Identifies opportunities for staff improvement, high performing team members, and training needs of team members.

23.  Partners with management to identify areas of opportunity within department and makes improvements on processes, culture, or work environment.

24.  Acts as a liaison between staff, management, and other functional departments for consistent improvements of functions and work flow.

25.  Identify misconduct and finds resolution and escalate to Human Resources.

26.  Travel to all company sponsored events, trainings, and locations based on business needs.

27.  Performs special projects and other duties as assigned and required.

Position Requirements: 

Education: Bachelor’s degree in behavioral health, healthcare administration or related field preferred (equivalent to 6-8 years of related work experience).  Master’s degree preferred (equivalent to 10-12 years of related work experience).

Licensure:  N/A

Relevant Work Experience:   

•       At least 10 years’ experience in healthcare in Managed Behavioral Health Organization setting.

•       Experience in data analysis, quality improvement activities, NCQA/URAC strongly preferred.

•       Experience with CA Department of Managed Health Care regulations.

•       Experience with grievance/complaint process, provider record review process, and potential quality issues process.

•       Experience from a quality perspective in dealing with Medi-Cal health plan audits.

•       Must be detail-oriented, able to work independently in a flexible environment, able to handle multiple tasks in an efficient manner and have excellent analytical and communication skills.

•       Must have some knowledge of cultural and linguistic competence principles and concepts and must be able to work effectively with culturally diverse staff and populations.

•       At least 10 years’ experience in healthcare.

Knowledge, Skills & Abilities:

•         Sound judgment and the ability to quickly analyze situations

•         Ability to establish priorities and meet deadlines

•         Ability to seek help in managing workload, when appropriate

•         Ability to problem solve in a proactive, creative manner

•         Ability to work independently within a virtual operating environment and as part of a team

•         Represent the company with professionalism

•         Excellent communication skills

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

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.

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