Quality Assurance/Quality Improvement Specialist - Behavioral Health

CANDIDATES MUST LIVE IN CALIFORNIA IN ORDER TO BE CONSIDERED FOR THIS POSITION. IF YOU DO NOT LIVE IN CALIFORNIA, PLEASE DO NOT APPLY.

Come work for a company that makes a difference within the communities of the State of California. This company works on cutting-edge prevention programming, providing counties with an independent administrative and fiscal intergovernmental structure. Our client helps fund, develop, and implement mental health services and educational programs in the state of California.

This company offers a VERY Generous Benefits Package, including:

• 10% company-sponsored retirement account (401a) 100% vested – additional compensation/retirement.
• Medical, Dental, Vision, LTD, Life Insurance, Wellness Program, FSA
• Generous PTO plan

Job Title: Quality Assurance / Improvement Specialist

Work Model: REMOTE

Schedule: Monday-Friday, 8 am-5 pm (Could vary depending on business needs)

Salary: $99K-125K

Department: Managed Care Operations

Reports To: Director and Senior Director of Managed Care Operations

FLSA Status: Exempt

Summary of Position:

This company is a Joint Powers Authority (JPA) serving California’s county-based Behavioral Health system of care. Our mission is to support counties in the service of the most vulnerable people living in the state.

This position is geared toward licensed behavioral health professionals whose passion lies in the realm of quality assurance, quality improvement utilization review, performance management and training development. Your work will directly impact California counties and you will work closely with our knowledgeable Managed Care Team that is comprised of clinical staff, data and epidemiological staff business analysts and other support staff.

Under the general direction of the Senior Director of Managed Care Operations, the Quality Improvement Specialist implements and monitors behavioral health quality assurance/quality improvement activities, identifies and monitors key performance indicators/program requirements, analyzes and reports on various data indicators and implements and tracks quality improvement activities. Additionally, this position will develop clinical trainings and educational/training materials, as well as conduct presentations to audiences of various sizes.

KEY ACTIVITIES:

• Implement and monitor quality management activities and initiatives, including clinical documentation and program auditing, creation of operational materials including manuals, policies & procedures, data analysis, establishing key performance indicators, identifying system performance improvements and implementing/evaluating improvement activities as warranted.
• Collect, analyze and effectively present data related to quality and performance management activities.
• Assist in the development and maintenance of clinical resource guides/manuals.
• Assist in the development of policies and procedures to ensure appropriate implementation of updated regulatory guidance and contractual changes for county Mental Health Plans (MHPs) and Drug Medi-Cal (DMC)/DMC-Organized Delivery System (ODS) Plans.
• Develop and facilitate behavioral health clinical trainings related to MHP and DMC/DMC-ODS contractual and regulatory requirements.
• Manage multiple projects with competing deadlines.
• Maintain a current understanding of the behavioral health rules, regulations, and guidelines from governing bodies and assure compliance with state, federal, and local requirements.

• Coordinate with relevant stakeholders including facilities, practitioners, and beneficiaries.

• Perform other duties as assigned.

REQUIRED EDUCATION/EXPERIENCE:

• The ideal candidate is not necessarily still working in a clinical setting but should have a background in clinical support.
• The role requires a lot of innovation, and the candidate should understand they will be involved in the creation.
• Tasks in the role include auditing, utilization review, documentation, and training.
• Relevant clinical license including LCSW, LMFT, LPCC, or PhD in the state of California.
• Minimum of two (2) years of behavioral health quality assurance/quality improvement experience.
• Experience with county (MHP) and DMC/DMC-ODS utilization management highly preferred.
• Familiarity with county compliance is crucial.

SKILLS AND ATTRIBUTES:

•  
• Ability to establish and meet tight deadlines
• Ability to multitask and organize multiple streams of work effectively; attention to detail and accuracy is required
• Hands on experience supporting quality improvement/utilization management operations and program/policy implementations.
• Effective written and oral communication skills; including an ability to synthesize information from a variety of sources
• Demonstrated sense of urgency, initiative, and responsiveness; proactive approach to work
• Must have strong interpersonal and communication skills - verbal and written
• Possess the interest and ability to work well with a multidisciplinary team to develop solutions to support members
• Highly analytical approach to problem analysis and problem-solving
• The ability to read, understand and implement regulatory language
• Ability to effectively collaborate with individuals with varying levels of skill

Physical and Sensory Requirements:

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit and stand; use phone and headset; use hands, arms, fingers to type; answer phones; write; use calculator; demonstrate strength to lift and carry materials weighing up to 10 pounds; demonstrate clear vision to read printed materials and a computer screen; hearing and speech to communicate in person and over the telephone.

SENSORY DEMANDS: The incumbent must spend long hours in intense concentration. The incumbent must also spend long hours on the computer entering information which requires attention to detail and high levels of accuracy.

MENTAL DEMANDS: There are a number of deadlines associated with this position, which may cause significant pressure. The incumbent must also attend to a wide variety of individuals regarding various topics/challenges.

TECHNOLOGY REQUIREMENTS:

• Internet speed must be 50 mbps download & 10 mbps upload to support our work. (hot spot only works for temporary connections)
• Personal devices, if applicable – Mac/iPad must be within 3 generations of current.  Windows – 10 or above.

CANDIDATES MUST LIVE IN CALIFORNIA IN ORDER TO BE CONSIDERED FOR THIS POSITION. PLEASE ONLY APPLY IF YOU ARE A CALIFORNIA RESIDENT. 

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