Manager, Clinical and Quality Operations in Woburn, MA at Beacon Health Options

Date Posted: 5/30/2018

Job Snapshot

Job Description


We are currently seeking a dynamic CLINICAL QUALITY OPERATIONS MANAGER to join our team at our office in Woburn, MA.  The Clinical Quality Operations Manager reports directly to the Director of Regional Clinical Quality Operations to provide clinical and quality operational and inter-departmental support, as well as, coordinate the functions of the regional clinical and quality teams.   In collaboration with the CQOD, the CQOM supports, oversees and participates in clinical and quality implementation activities.

Position Responsibilities:

  • Assists in the clinical and quality operation management of the Region, serves as an expert resource and facilitates clinical & quality operations engagement between functional units i.e. Aftercare, Quality, Provider Quality, and the Case Management pods.

  • In collaboration with the CQOD and Corporate Quality Accreditation, ensure ongoing compliance with accreditation (NCQA and URAC) standards.

  • Responsible for assisting with new client implementations (inclusive of new services on existing client) for clinical and quality components.

  • Lead on clinical & quality aspects of audits collaborating with corporate quality accreditation (internal audits), Ops Pod and account partnerships as needed.

  • Ensures contractual and delegation agreement compliance for the Region.

  • Project manages cross-department initiatives within the Region, and across Shared UM Services

  • Assists in the development of contractual reporting requirements as needed.

  • Acts as a liaison between CQO, Ops Pods, Shared UM Services, and Care Management to maintain operational procedures and updates.

  • Leads cross regional teams to ensure adherence with accreditation, compliance and other contractual requirements. Activities may include workflow development, system enhancement, measurement review, and process improvement.

  • Proposes clinical and/or quality solutions to business issues/problems utilizing appropriate analytic tools and business processes to ensure quality, cost effectiveness, timelines, with awareness of contractual and regulatory requirements/mandates.

  • Works with the Regional Quality Director and team to coordinate quality control on clinical and quality deliverables, implementations and ad hoc requests.

  • Lead representative in cross-departmental Regional meetings to support accreditation. (i.e., QIC, UM/CMC).

  • Lead representative in external account meetings (BHOC, JOC, etc.).

  • Other duties as assigned.

Position Requirements:

  • Education: The position requires a minimum of a Bachelor’s Degree in a related field (healthcare administration, behavioral sciences, business, project management). A Master’s degree in a healthcare field is desired but not required. 
  • Licensure: Current, valid and unrestricted licensure
  • Work Experience:
    • A minimum of 5-7 years combined direct behavioral health, supervisory and/or managed care experience required.

    • Preferably five years managed behavioral healthcare or related experience

    • A working knowledge of account management, customer relations and business management are essential

    • The candidate must have a strong customer service orientation, excellent written and verbal communication skills, and experience using management information systems

    • Knowledge and experience related to clinical services will be beneficial.

Knowledge, Skills & Abilities:

  • Leadership skills and supervisory experience, including the ability to develop team performance

  • Excellent written and oral communication skills; excellent negotiation skills

  • Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.

  • Demonstrated understanding of CQI - knowledge of principles and ability to manage change

  • Ability to manage and coordinate with internal and external departments

  • Demonstrated leadership and management skills and experience, including the ability to work cross-functionally, build consensus and develop staff

  • Ability to manage time-sensitive projects and meet deadlines

  • Ability to identify opportunities for improvements and recommend and implement innovative solutions.

  • Able to work collaboratively with internal staff and external providers/clients

  • Must be detail oriented; able to work independently in an ever changing environment                       


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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