Quality Management Specialist II - (California Licensed Clinician required) in Cypress, CA at Beacon Health Options

Date Posted: 10/1/2019

Job Snapshot

Job Description

Beacon is currently seeking a Quality Management Specialist II (Master’s level California Licensed Clinician required) to join our team at our Cypress, CA office.  Experienced quality management professional with a strong clinical focus to provide critical evaluation and monitoring of clinical and quality process improvements to meet NCQA standards, HEDIS® monitoring and reporting requirements.  The Quality Management Specialist II is an experienced quality professional and is responsible for the coordination, planning, development, implementation, and monitoring of quality management and improvement processes and activities in Regions 4 and 5. This position is based in Cypress, CA.

What does a typical day look like?

  1. Coordinates and manages key aspects of accreditation (URAC/NCQA) and other regulatory requirements.
  2. Conduct audits/internal assessments of clinical and operational activities to ensure compliance with corporate policies, quality management activities, accreditation standards and client performance guidelines.
  3. Serves as a liaison to Health Plan clients related to clinical quality deliverables, including delegation audits and clinical performance measures.
  4. Prepares written assessment reports, internal document tracking and executive summaries that describe programs, methods, barriers, results, operational strengths, interventions, opportunities for improvement and recommendations.
  5. Provide ongoing support for accreditation survey preparation.
  6. Serves as an internal consultant for performance improvement activities
  7. Participates in internal and external Quality Management Committees or Workgroup activities.
  8. Assists with the facilitation of the QMUMCM Committee meetings and Quality of Care committee meetings by organization meeting materials, preparing agendas, and completing minutes.
  9. Provides analysis for various QM and review activities
  10. Conducts provider chart audits and collaborate with providers regarding audit findings.
  11. Processes grievances, adverse incidents, and quality of care cases including mailing letters, conducting research, presenting information at Quality of Care / Peer Review Committee, and tracking and trending to identify opportunities for improvement.
  12. Handles requests for medical records by member, health plan and/or regulatory agency.
  13. Works closely with Regional Quality, Clinical, Operations, Member Services, Provider Partnerships, Account Management, Network and Provider Relations at a local level to ensure comprehensive, efficiency and integrated systems that ensure communication and positive outcomes.
  14. Adheres to all Beacon policies and procedures and standards of operations.
  15. Completes all required and assigned trainings.
  16. Attends all mandatory company or department meetings.
  17. Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
  18. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  19. Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.
  20. Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
  21. Assist team members and offers suggestions to improve processes, culture, or work environment.
  22. Performs special projects and other duties as assigned and required.
  23. Performs other duties as assigned.

What you Contribute?

Education: Master’s Degree required in one of the following related fields: QM, Psychology, Behavioral Health, Statistics or RN with relevant QM or Managed Care Experience.

Licensure: Master’s level California Licensed Clinician required.

Knowledge, Skills & Abilities:

  • 3-5 years Quality Management experience required.
  • Three years’ experience in a managed care environment. Must possess skills and abilities in needs assessment, program development, design, organization, implementation, facilitation and evaluation; proven ability and experience in community relations/networking and information and resource development and maintenance, established knowledge of and work experience with the Medicaid affiliated population desirable.  
  • Knowledge of Department of Managed Health Care Knox-Keene Regulations preferred.
  • Must have previous systems/data analysis experience, preferably in a mental health care setting.
  • Proficiency in current versions of Windows, MS Word, MS Excel or similar spreadsheet packages.
  • Strong interpersonal skills and good written and verbal communication skills.

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 thinkers.
  • 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.