Manager Quality Operations (Licensed) in Boston, MA at Beacon Health Options

Date Posted: 12/15/2019

Job Snapshot

Job Description

We are actively seeking a results-drive Manager Quality Operations to join our growing team in Boston, MA! This role will be responsible for ensuring the integrity of MBHP internal quality operations; improving quality of care among providers; maintaining NCQA accreditation; organizing clinical and quality management training for internal staff and network providers.

What does a typical day look like?

  • Directs the quality operations unit within the quality department, including: overseeing adverse incident and complaints investigations; supervising review of written provider compliance action plans; and ensuring provider implementation of corrective quality improvement plans.  Provides leadership in collaborating with all inter-departmental staff.
  • Utilizing clinical and regulatory expertise, serves as the Quality Department expert and liaison to the Clinical Management Committee and clinical areas, responsible for the auditing of all denial and appeal files.
  • Ensures programmatic compliance with standards established by external accrediting agencies, as well as facilitating the annual review of the Partnerships policies and procedures.
  • Develop and participate in the implementation of an annual strategic training program for network providers, and assume responsibility for the Partnership’s internal quality management training curriculum.
  • Oversees Clinical Practice Guideline adoption and annual record review and implements performance improvement plans to increase adherence to best practices.
  • Accountable for all medical record review deliverables and reporting, as well as provider communication for quality improvement planning.
  • Responsible for the design, measurement and evaluation of quality operations performance indicators and associated reporting per contract requirements and business needs.
  • Directs the Partnership’s Risk Management Committee and leads the investigation and presenting of all risk cases or suspected cases of fraud and abuse.
  • Participates in Beacon Health Options’ quality management committees.
  • Chairs Risk Management committee.
  • Implements strategic goals for the Partnership’s Quality Management (QM) Program.
  • Develop the annual Quality Management Program Description, workplan and annual program evaluation and submit to clients for review and approval.  Ensure Partnership’s compliance with generally accepted quality management principles.
  • Participates in NCQA accreditation including development of workplan to ensure compliance with all standards.  Ensures all reporting is timely, and that all documentation is complete and timely, meeting all requirements. 
  • Accountable to the Senior Leadership Team for identifying resources required and barriers to maintaining accreditation.

What Makes Us Different?

  • Here, it’s not just a job – it’s an opportunity to change lives.
  • Our employees are learners, innovators and original
  • Our mission and values guide the way we treat our members, providers and each other.

What We Have to Offer:

  • Healthcare benefits available starting day 1!
  • Health & wellbeing incentives, such as gym membership reimbursement
  • 401K with company match to help reach your future financial goals
  • Generous PTO, because we know life happens outside of work
  • Tuition reimbursement so you can keep reaching your fullest potential

If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

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.

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