Dir Qual Mgmt in New York, NY at Beacon Health Options

Date Posted: 7/23/2019

Job Snapshot

Job Description

The Regional Director of Quality Management reports  to the AVP of Quality, and is responsible for the Quality operations within the Region, and ongoing compliance with NCQA MBHO and URAC standards. The role requires knowledge of Company, NCQA MBHO and URAC HUM standards and requirements, as well as specific contractual standards and requirements as they apply to each account. The Regional Director monitors, supports and directs the integration of these standards and requirements into day-to-day operations, identifies areas for operational improvement, and assists in the development of strategies and processes to improve. The Regional Director also will play a key role in the implementation of the carve-in of NYS Children’s Services into Managed Medicaid, and other new contracts.

Position Responsibilities:

  • Provide supervision and oversight to Quality Teams in NY. Ensure that all quality operations are integrated into day to day operations and meet accreditation standards and client deliverables
  • Lead, participate, or ensure Beacon Quality participation in Key Committees. Examples include:
    • Quality/Utilization/Case Management (QM/UM/CM) Committees
    • Client specific Quality Committees, including Joint Oversight Committees
    • Other Client meetings as indicated
  • Oversee and support the Service Center Quality activities for New York contracts including Aftercare Follow up, Quality of Care, and HEDIS improvement program activities
  • Review and analyze client specific reports related to Quality such as Quality of Care, Complaints and Grievances, HEDIS monitoring, etc.
  • Participate in the development and coordination of client and accreditation audits, surveys and data systems.
  • Produce Quality documents as required by contract
  • Act as strategic thinker, leader and problem-solver for efficient operational functioning among the New York offices and interdependent departments such as Clinical, Medical, Network/Provider Relations, Provider Partnerships, Strategy and Development.
  • Problem solve with the Beacon leadership in New York , when issues or problems occur that impact the successful completion of client quality deliverables, as well as meeting performance guarantees or SLAs.
  • Supervise and evaluate performance of quality management staff.
  • Mentor staff to meet professional potential. Monitor performance and conduct timely annual performance appraisals; assesses training needs and coordinate resources to ensure performance and training issues are addressed timely.
  • Keep AVP apprised of staff progress and significant issues and needs.
  • Other duties as assigned.

Beacon Health Options 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.