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Manager Quality Operations
Beacon Health Options
 
Job Location: Boston, MA
Beacon Health Options

Job Category: Clinical - Quality Mgmt
Req #: MANAG01250
Schedule: Full Time
Location: MA - Boston


About The Position:

We are actively seeking a results-drive Manager Quality Operations to join our growing team in Boston, MA! This role will beresponsible for ensuring the integrity of MBHP internal quality operations; improving quality of care among providers; maintaining NCQA accreditation; organizing clinical and quality management training for internal staff and network providers.

Duties and Responsibilities
  • Directs the quality operations unit within the quality department, including: overseeing 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 Clinical Management Committee and clinical areas, responsible for the auditing of all denial and appeal files.
  • Ensures programmatic compliance with standards established by external accrediting agencies, as well as facilitating the annual review of the Partnerships policies and procedures.
  • 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.
  • Oversees Clinical Practice Guideline adoption and annual record review and implements performance improvement plans to increase adherence to best practices.
  • Accountable for all medical record review deliverables and reporting, as well as provider communication for quality improvement planning.
  • 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 Beacon Health Options' quality management committees.
  • Chairs Risk Management committee.
  • Implements 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 for review and approval. Ensure Partnership's compliance with generally accepted quality management principles.
  • Participates in NCQA accreditation including development of workplan to ensure compliance with all standards. 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.

Position Requirements:

Education: Master's degree required in mental health or substance abuse services

Licenses: Clinical license appropriate to the master's degree preferred

Years and Type of Relevant Work Experience: A minimum of three years of managed behavioral health experience required

Skills:
  • Must be able to work cooperatively as part of a team.
  • Requires excellent interpersonal skills and an ability to provide maximum customer service in order to promote a positive company image.
  • Must be able to effectively communicate with internal and external clients in verbal and in written formats.
  • Self-motivated, results driven individual with demonstrated ability to work in an extremely complex environment.



Beacon Health Optionsis proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

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