QUALITY MGMT SPEC II in Atlanta, GA at Beacon Health Options

Date Posted: 10/21/2018

Job Snapshot

Job Description

General Summary    

We are currently seeking a Quality Management Reviewer to join our team in Georgia.  The QM Reviewer  will be responsible for conducting quality reviews on-site at provider locations.  Candidates must be able to travel extensively within the state in assigned geographic areas.  Position will be remote from home.  Canidate must reside in GA.

Duties and Responsibilities

  • Conduct contract-required quality records reviews and participate in other monitoring assignments as required. (e.g. Technical Assistance Consultation/ Claims Documentation Reviews).

  • Work with clinical, provider relations and QM Departments to establish and maintain a process for regular treatment record reviews; conduct treatment record audits, compile and report results.

  • Coordinate and communicate provider monitoring and improvement activities and results within QM Department as well as inter-departmentally. Support service center department directors in developing processes for oversight of high-risk areas associated with delegation, contract and provider monitoring requirements.

  • Identify trends and patterns of deficiencies within the medical; evaluate results, identify and communicate areas for improvement within the system.

  • Conduct Individual and Staff interviews, compile and report results.

  • Prepares written reports on QI activities that describe results, strengths, opportunities for improvement and recommendations.

  • Prepares and presents trainings to providers, as needed.

  • Maintains confidentiality, ethical and professional standards, personal standards of cultural competency, and leads by example.

  • Performs other duties as assigned.

    Minimum Entry Level Qualifications

    Education: Master's degree in health related field or 5 years of experience in a behavioral health related field.

    Licensure:  Licensure in a mental health related field (Ph.D., RN, LCSW, LPC, LMFT, LMSW, etc.), RN preferred. 

  • Minimum three (3) years’ work experience in Quality Management or healthcare field. Knowledge of QI philosophy and techniques and state, federal guidelines and regulations preferred.

  • Relevant Work Experience:   Experience in behavioral health. Requires experience with treatment record documentation or some clinical or quality-related knowledge of treatment record documentation requirements, ability to understand contract and other regulatory requirements.  Knowledge of the Georgia DBHDD Provider Manual preferred. Experience conducting audits, training and basic knowledge of procedure codes, strongly preferred.

TO APPLY

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Beacon Health Strategies, LLC., 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