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Date Posted: 1/17/2019

Job Snapshot

Job Description


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

Position Responsibilities:

  1. As directed by the AVP/Director of Quality, oversee of daily clinical/ quality operations. Daily operations include: processing of grievances, adverse incidents, quality of care, 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 Regional/Corporate Quality Improvement Activities (QIAs) teams. Understand the various Health Plan member population and implement activities accordingly to improve quality of care and service to BHS members.
  5. Responsible for assuring that Beacon remains in compliance with NCQA standards pertaining to quality operations.
  6. Assist in NCQA desktop audit through coordination with other departments, evidence gathering, and, annotation and submission through NCQA web portal.
  7. 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.
  8. 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.
  9. Participate in implementation of new contracts.
  10. Analysis of current processes and work flows to develop more efficient work flows surrounding clinical/quality operations
  11. Serve as the lead for Cultural and Linguistic (C&L) Program. Which will include development and implementation of the C&L work plan.
  12. Update the program description annually as necessary
  13. Develop literature and educational materials for members and providers
  14. Gather training materials for staff
  15. Coordinate directly with translation vendor to provide translation services
  16. Adheres to all Beacon policies and procedures and standards of operations.
  17. Completes all required and assigned trainings.
  18. Performs annual staff reviews and establish individual/team goals for development.
  19. Motivates team members to reach department goals and objectives.
  20. Attends all mandatory company or department meetings.
  21. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  22. Acts as a mentor to team members by leading by example and guiding with a sense of integrity and teamwork.
  23. Meets regularly with team members for one on ones and staff meetings.
  24. Identifies opportunities for staff improvement, high performing team members, and training needs of team members.
  25. Partners with management to identify areas of opportunity within department and makes improvements on processes, culture, or work environment.
  26. Acts as a liaison between staff, management, and other functional departments for consistent improvements of functions and work flow.
  27. Identify misconduct and finds resolution and escalate to Human Resources.
  28. Travel to all company sponsored events, trainings, and locations based on business needs.
  29. Performs special projects and other duties as assigned and required.

Position Requirements:

Education: Bachelor’s degree in behavioral health, healthcare administration or related field required.  Master’s degree preferred.

Licensures: CA Clinical Licensure required

Relevant Work Experience:   

  • At least 10 years’ experience in healthcare and managerial experience
  • Experience with quality operations
  • Experience with process improvement
  • Experience with NCQA strongly preferred
  • Must be detail-oriented, able to work independently in a flexible environment, able to handle multiple tasks in an efficient manner and have excellent communication and writing skills.
  • Can-do attitude and ability to work collaboratively with internal staff and external parties.


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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