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  • Boston, MA

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DIR QUAL OPS & COMPLIANCE

Beacon Health Options • Boston, MA

Posted 9 days ago

Job Snapshot

Full-Time
Experience - At least 5 year(s)
Healthcare - Health Services
QA - Quality Control
0

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Job Description

General Summary: Responsible for ensuring the integrity of MBHP internal quality operations; improving quality of care among network providers; maintaining NCQA accreditation; organizing clinical and quality management training for internal staff and network providers.

Essential Duties and Responsibilities:

  • Develop, direct and implement strategic goals for the Partnership’s Quality Management (QM) Program.

  • Develop the annual Quality Management Program Description, workplan and annual program evaluation and submit to clients and ValueOptions for review and approval.  Ensure Partnership’s compliance with generally accepted quality management principles. 

  • Accountable for the MBHP quality department in the absence of the VP of Quality Management, including assuring the timely completion of all contact deliverables. 

  • Responsible for NCQA accreditation including development of workplan to ensure compliance with all standards, serve as the liaison with ValueOptions quality team and NCQA staff and directs NCQA Project Manager.  Ensures all reporting is timely, and that all documentation is complete and timely, meeting all requirements. 

  • Accountable to the Senior Leadership Team for identifying resources required and barriers to maintaining accreditation.

  • Ensures programmatic compliance with standards established by external accrediting agencies, including facilitating the annual review of the Partnerships policies and procedures.

  • Works with the Director of Quality Project Analysis to ensure that all projects are completed as required for NCQA accreditation. 

  • Responsible for oversight of operationalizing surveys for Members, behavioral health providers and primary care clinicians. 

  • Directs the quality operations unit within the quality department, including: supervising the QM specialists; supervising the appeals process, adverse incident and complaints investigations; supervising review of written provider compliance action plans; and ensuring provider implementation of corrective quality improvement plans.  Provides leadership in collaborating with all inter-departmental staff. 

  • Utilizing clinical and regulatory expertise, serves as the Quality Department expert and liaison to the Utilization Management Committee and clinical areas, responsible for the auditing of all denial and appeal files.

  • Develop and participate in the implementation of an annual strategic training program for network providers, and assume responsibility for the Partnership’s internal quality management training curriculum.

  • Responsible for the design, measurement and evaluation of quality operations performance indicators and associated reporting per contract requirements and business needs.

  • Directs the Partnership’s Risk Management Committee and leads the investigation and presenting of all risk cases or suspected cases of fraud and abuse.

  • Participates in ValueOptions’ quality management committees.

Minimum Qualifications:

Education:       Master’s degree required in mental health or substance abuse services
Licensures:       Requires a clinical license appropriate to the master’s degree

Relevant Work Experience: 

  • A minimum of five years of managed behavioral health experience required with a minimum of three years of experience managing and supervising quality management staff preferred.

Other Job Specific Skills:

  • Detail-oriented analysis ability

  • Excellent people/customer skills

  • Excellent time management abilities

  • Excellent project management skills

  • Excellent documentation ability

  • Team Player

  • Staff training skills

  • Strong written and verbal communication skills

  • Public speaking

  • Strong writing skills    

  • Interpersonal skills including negotiation and conflict resolution    

TO APPLY

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

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

Job ID: 53409
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