Program Integrity Director Jobs in Pennsylvania (NOW HIRING)

The Quality Reporting and Accreditation Specialist will serve as the primary project manager for CBH’s effort to obtain and maintain National Committee for Quality Assurance (NCQA) accreditation Managed Behavioral Health Organization Accreditation, Certified Review Entity Certification, and HealthChoices Reporting. The Quality Reporting and Accreditation Specialist will also assist the Director of Quality Improvement in the monitoring, documenting, and reporting of quality management activities.

Essential Functions:

• Serves as project manager for coordinating and collaborating with accreditation and certification entities and the Office of Mental Health and Substance Abuse Services to ensure compliance with accreditation, certification, and HealthChoices requirements. Prepares CBH for accreditation, certification, and HealthChoices submissions and reviews.
• Develops tools that assist in determining exposure to quality risks and identifies opportunities to manage and mitigate those risks.
• Compiles information for quality improvement and monitoring activities, and accreditation/certification for internal use and external audits, and maintains relevant records.
• Works with internal departments to develop metrics to accomplish program objectives and monitors action plans relating to improving compliance with accreditation/certification requirements and quality improvement activities.
• Makes recommendations to CBH Officers and Quality Improvement Committee for improvements or remediation to ensure compliance to accreditation, certification, and HealthChoices requirements.
• Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste, or abuse.
• Responsible for coordinating messaging of quality improvement and monitoring activities to internal and external stakeholders.

Education:

• Education: Master’s degree in behavioral health, healthcare, public administration, or social sciences.
• License/Certification (if applicable): Certified Professional in Healthcare Quality (CPHQ) preferred; CPHQ Required within 1 year of hire;
• Project Management Professional (PMP) certification is preferred.
• Relevant Work Experience: Minimum of 3 years post-graduate experience.

Skills:

• Mid to high level proficiency with Microsoft Office applications
• Excellent written and verbal communication skills
• Knowledge of HealthChoices regulations and requirements
• Knowledge of NCQA requirements
• Detail-oriented and highly organized
• Knowledge of quality management, assurance, and improvement principles
• Ability to work effectively with all levels of staff
• Ability to manage ongoing projects and prioritize appropriately to meet deadlines

CBH is a dynamic organization dedicated to providing access to high-quality, accountable care to improve the health and mental wellness of our members. CBH offers a robust compensation and benefits package, including:

• Family Planning, Fertility, Adoption Benefits
• 403B Retirement Plan
• PTO Days/Sick Days
• Wellness Program
• Employee Assistance Program
• Health, Dental, Vision Insurance
• Medical, Prescription Drug Insurance
• Tuition Reimbursement
• Commuter Benefits
• Flexible Spending

Core Competencies:

• Teamwork and Collaboration: Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.
• Respect: Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.
• Member Centric: Focus on the needs of our members by providing value-added services, promoting strong relationships and going beyond basic expectations to achieve the best possible outcomes.
• Honesty and Integrity: Be open and honest in all we do. Maintain the highest level of integrity at all times.
• Commitment to Service Excellence: Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service and high quality, innovative programs.
• Compassion and Empathy: Demonstrate a deep appreciation for another’s situation and point of view. Pay attention to emotional cues, listen effectively and show an exceptional level of caring about each person’s perspectives and circumstances.
• Problem Solving: Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints and CBH values into consideration.
• Initiative and Self-Directed: Proactively manage time and resources in a way that ensures that all work is done in the most efficient manner while identifying and implementing initiatives without interventions from co-workers, supervisors or stakeholders.
• Flexibility and Adaptability: Adjust approaches and behaviors in order to meet the constantly changing environment head-on and accomplish CBH and individual goals. Strive to adapt to, accept and embrace change within areas of responsibility.
• Communication: Effectively and appropriately share thoughts, ideas and information - both written and oral. Respectfully listen to co-workers and stakeholders to gain a full understanding of issues/situations.

Leadership Competencies:

• Strategic Thinking: Understand and integrate the long-term vision of CBH and focus current activities on what is critical to achieve future success including formulating objectives/priorities and developing and implementing breakthrough ideas.
• Leadership: Effectively manage and guide efforts to address challenges and drive continuous improvement for CBH’s programs, services and processes. Develop and implement effective strategies and appropriate interpersonal styles to influence and guide others.
• Employee Development: Recognize and promote the necessity to hire, assess, develop and retain high quality talent. Acknowledge strengths and weaknesses in team members through an ongoing performance management process that provides timely feedback in order to help them develop and enhance performance.

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov