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Job Location: Woburn, MA
Beacon Health Options
Job Category: Clinical - Quality Mgmt
Req #: AVPRE01265
Schedule: Full Time
Location: MA - Woburn
ABOUT THE POSITION
The AVP Regional Quality is responsible for managing the development and execution of quality activities and processes in the NortheastRegion.
Own delivery of exceptional quality operations
- Primary interface with client in Quality related committees including Delegation Oversight meetings and audits
- Produce annual Regional QM Trilogy Documents, including tracking and updating Work Plan activity progress
- Implement corporate policies and create local quality addenda and SOPs when needed
- Produce and oversee production of client and contractual reports and reports required for meeting accreditation standards
- Provide Quality thought leadership to Sales teams/RFPs, and author quality-related articles for members and providers
- In collaboration with the Vice President, Regional Clinical and Quality Operations and corporate quality accreditation ensure ongoing compliance with accreditation (NCQA and URAC) standards.
- Assist Corporate Quality in preparation for NCQA or URAC accreditation survey
- Train/coach team members on corporate, market, and regulatory developments that impact their roles and functions
- Lead for Regional Quality Committee structure, Chair Regional QMUMCM Committee, Co-chair Regional Quality of Care Committee
- Report monthly to Corporate Quality Committee (CQC) on regional quality, UM and clinical activities as well as metrics and outcomes
- Regional lead on Member Satisfaction survey administration and analysis in collaboration with Corporate Quality
- Conduct specific quality trainings as requested by Corporate Quality for monthly quality training series
- Oversee and manage the complaints and grievances process for the region
- Oversee & manage Quality staff in the region
Lead quality performance improvement, implementation, and program development
- Collaborate with the Vice President, Regional Clinical and Quality Operations to charter improvement activities to support accreditation and performance improvement including developing, implementing, monitoring and tracking performance of Regional quality programs
- Participate with Corporate Quality and other Regional Quality leads in the charter of Quality Improvement Activities (QIA) to support both Beacon Health Options and Beacon Health Strategies accreditation.
- Oversee QIA program development ensuring fidelity to the CQI model
- Lead EQRO projects in collaboration with clients
- Collaborate with Regional Clinical Managers and the Vice President, Regional Clinical and Quality Operations to track performance of Core Performance Indicators (CPIs)
- Collaborate with health plan clients on HEDIS BH measures measurement and improvement opportunities
- Collaborate with Corporate Quality on HEDIS rate production and client deliverables
- Monitor PGs and SLAs relating to quality, and implement and monitor CAPs in collaboration with internal stakeholders, clients, and providers
- Implement and monitor CAPs related to Corporate Quality as well as external client delegation and regulatory audits for accreditation readiness
- Coordinate with Compliance on program integrity issues
Coordinate with Ops Pod to resolve quality issues
- Collaborate with the Vice President, Regional Clinical and Quality Operations and Ops Pod Leaders to develop effective and efficient processes for Quality to interface with Pods to solution a range of client and provider quality issues
- Demonstrate nimbleness and creativity in rapid prototyping of different Ops Pod collaboration models
Key Performance Indicators
- Client satisfaction with clinical quality performance (e.g. HEDIS)
- Improvement in HEDIS BH measures
- 100% pass rate of all internal and external quality audits
- Effective partnering with UM Shared Services, Care Management, MPPs, Aftercare, Network, Analytics Innovation Center, Knowledge Management and Reporting, Ops Pods, etc.
- Talent development and coaching
- Master's degree in Behavioral Health field required
- Preferred but not required: Current, valid and unrestricted licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 3 years.
- A minimum of 3-5 years combined direct behavioral health, supervisory and/or managed care experience required.
- Leadership skills and supervisory experience, including the ability to develop team performance
- Excellent written and oral communication skills
- Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.
- Ability to manage and coordinate with internal and external departments
- Ability to manage staff in operations environment
- Demonstrated leadership skills and experience, including the ability to work cross-functionally, build consensus and develop staff
- Ability to manage time-sensitive projects and meet deadlines
- Ability to identify opportunities for improvements, recommend, and implement innovative solutions.
- Must be detail oriented; able to work independently in an ever changing environment
Beacon Health Options company 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
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