AVP Clinical Quality in Grand Rapids, MI at Beacon Health Options

Date Posted: 9/25/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic AVP, Clinical Quality to join our team at our office in Grand Rapids, MI.  The AVP, Clinical Quality will be responsible for development, management and implementation of clinical and quality programs and operations; regional provider strategy performance improvement; client issues; and management of medical loss ratio issues within the region

Position Responsibilities:

  • Deliver effective and efficient clinical, quality, and provider quality operations

  • Oversee regional CM programs, including complex case management, intensive case management, care coordination, and case consultation

  • In collaboration with internal and external stakeholders build sustainable integration programs and activities

  • Lead annual production of UM/CM/QM Regional Trilogy Documents, including monitoring work plan activity completion

  • Manage and monitor implementation of aftercare program including collection of Non Standard Supplemental Data (NSSD)

  • Oversee Provider Quality activities, such as supporting regional Provider Strategy (e.g., Select, VBPs, national initiatives) and monitor outcomes through use of a Provider Quality Manager, as appropriate/available

  • Direct and oversee regional clinical and service quality programs led by the Regional Quality lead

  • Develop Regional SOPs to support Corporate wide clinical, quality, and provider strategy policies when needed

  • Under the direction of Corporate Quality, ensure compliance with NCQA MBHO and URAC standards and contractual requirements

  • Ensure adequate participation in Corporate Quality Committees, specifically Corporate Quality Committee, Corporate Medical Management Committee, Corporate Utilization Management/Care Management Committee

  • Chair or assign designee for regional clinical, quality and provider Strategy team meetings

  • Oversee and assign team members to implement new clinical programs, new client implementations assuring all deliverables for clinical, quality and provider partnerships are met

  • Work with the account team, the CMO and the growth officer in the region, ensuring client, clinical and quality requirements are met

  • Monitor client clinical and quality CAPs and PGs for the region(OPS)

  • Collaborate with proposals and sales on new business development opportunities for supporting regional growth.

  • Represent Regional Clinical, quality, and provider quality on cross regional business development opportunities

  • Responsible for monitoring performance improvement and program development activities

  • Ensure that performance metrics across all clinical, quality, and provider quality are accurately and consistently monitored

  • In collaboration with Corporate Quality and other regional center, proactively identify areas requiring performance improvement, and collaborate with stakeholders to develop improvement activities

  • Ensure successful completion of all internal and external accreditation, delegation, compliance, and legal audits

  • Oversee implementation of new clinical business, products, and specialty programs (e.g. Here For You)

  • Oversee all clinical operations throughout the region under Director, Clinical/Quality Operations

  • Collaborate with UM functional area, Medical Affairs, Reporting and Analytics, and Finance for client contracts, including implementation and tracking of targeted intervention strategies and pricing/target feedback

  • Collaborate with Ops Pod Leaders to develop effective and efficient processes to interface with Ops Pods to solution a range of client and other clinical, quality and operational issues

  • Oversee and Monitor Key Performance Indicators

  • Ensure Health Plan partner satisfaction with Beacon’s collaboration and integration activities

  • Support improvement of HEDIS BH Measures as applicable

  • Monitor clinical/quality operations in all health plan audits

  • Champion of performance improvement and the CQI process

  • 10-20% travel

Position Requirements:

Education:    

Master’s Degree in a behavioral health discipline required

Licenses:

Independent practice license (LCSW, LPC, LMFT, APN)

Years and Type of Relevant Work Experience:

            At least 10 years’ experience in progressively more responsible leadership positions in clinical/utilization/network management in the behavioral health managed care field (public or private sector) or human services sector.

TO APPLY

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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