Quality Management Specialist in Rocky Hill, CT at Beacon Health Options

Date Posted: 10/5/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Quality Management Specialist to join our team at our office in Rocky Hill, CT!  The Quality Management Specialist reviews provider treatment records as part of the CT BHP Record Review Program for the purpose of ensuring quality of care, verifying documentation to support information received during medical necessity reviews, and confirming conformance with treatment record documentation standards. 

Participates in the Quality of Care Committee and plays an active part in coordinating the tasks involved in keeping that committee functioning at a high level.  Participates in audits of Beacon clinical staff documentation for thoroughness. 


     POSITION RESPONSIBILITIES

1.  Assists in the identification and notification of providers who will participate in the treatment record review process.  Arranges all necessary details to begin on site review and communicates with providers as necessary.

2.  Conducts record reviews in a timely and accurate manner and summarizes salient preliminary findings with the provider at conclusion of review. 

3.  Prepares final reports to providers by summarizing findings and identifying required actions in consultation with review team.

4.  Communicates with provider following review to ensure that required reports are received in a timely fashion.  Reviews recommendations of final report with provider.

5.  Maintains accurate reporting of record review status, e.g., scheduled review date, completion dates, dates of reports completed, number of records reviewed, provider response due date, and date of next review.

6.  Participates in periodic inter-rater reliability testing for record review accuracy and achieves a passing grade.

7.  Provides technical assistance to providers regarding medical record maintenance.
 

8.  Works effectively with all Beacon departments to ensure provider compliance with plans of correction.
 

9.  Plays a lead role in maintaining the Quality of Care Committee including maintenance of files associated with the committee and meeting minutes.
 

10.  Review provider records submitted to Beacon based on potential quality of care concern.  Elevate for medical director review as appropriate.
 

11.  Maintains a working knowledge of Beacon documentation standards and requirements.
 

12.  Conduct internal documentation audits of Beacon clinical staff documentation.

 

Position Requirements:

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


Licensure: Nursing (RN) or Social Work (LCSW) with 3 years of UM or QM experience or non-licensed with 5 years of UM or QM experience; CPHQ preferred.

Relevant Work Experience: A minimum of one year of previous Quality Management experience required; behavioral health managed care experience preferred

Knowledge, Skills & Abilities : Expert and proficient knowledge, skills and abilities in the following:

  • MS Word, Excel, PowerPoint, Outlook, and Project
  • Analysis and problem solving, Interpersonal communication, verbal and written communication, Group presentation and public speaking. Collaboration and team oriented work philosophy.


TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options, Inc., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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