Quality Mgmt Spec Ii

Company Name:
ValueOptions, Inc., a Beacon Health Options company
ValueOptions, Inc., a Beacon Health Options company
ValueOptions 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.
Position Location: NY - Latham
AAP Reporting Location: NY - Latham
ID: 32895
Job Family: Quality Management / Performance Improvement
FTE Status: Full time
Scheduled Weekly Work Hrs: 40
Workday Schedule: Weekdays Only
Workday Start Time: 8:30 am
Workday End Time: 5:00 pm
Variable Work Schedule:
We are currently seeking a dynamic Quality Management Specialist II to join our team at our office in Latham, New York. The Quality Management Specialist II will be responsible for coordinating the planning, development, implementation, monitoring and analysis of quality management processes and activities.
Position Responsibilities:
1. Coordinates and manages key aspects of both URAC and NCQA regulatory requirements including but not limited to:
knowledge of the standards
working with the team to meet and/or exceed the standards
maintenance of necessary and relevant documentation history
completion of NCQA and URAC documentation requirements
2. Conduct audits/internal assessments to ensure compliance with contract requirements, corporate policies, quality management activities and accreditation standards.
3. Prepares written assessment reports, internal document tracking and executive summaries that describe programs, methods, barriers, results, operational strengths, interventions, opportunities for improvement and recommendations. Ensures a comprehensive and analytic document.
4. Provide ongoing support for accreditation survey preparation.
5. Assist in the oversight of organization-wide or service center-wide quality improvement activities.
6. Monitor and analyze performance through data collection, tracking and analysis. Identify improvement opportunities and recommend quality improvement activities.
7. Serves as an internal consultant for organization-wide or service center-wide quality improvement activities including:
facilitation and coaching
coordination of QIA, surveys, research and other supporting functions
use or teaching of QI methods, tools, etc.
role model for QM principles and practices
8. Participate in the development and implementation of QM policies and procedures. Periodically review and revise, as appropriate.
9. Participates on or leads Quality Management Committee or Workgroup activity.
10. (Licensed Staff Only) Provides clinical analysis for various QM and review activities including:
Quality of Care Cases
Clinical Peer Review Coordination
Treatment Record Review
CCM audits
11. Works closely with Clinical Operations, Customer Service, Account Management and Provider Relations at a local and corporate level to ensure comprehensive, efficient and integrated systems that ensure communication and positive outcomes.
Position Requirements:
Education: Master's Degree in one of the following related fields: Psychology, Behavioral Health, Statistics OR Nursing Degree (RN)
Licensures: Nursing (RN) or Social Work (LCSW) preferred.
Certifications: CPHQ preferred.
Relevant Work Experience: Licensed candidates: 3 years of Utilization Management/Quality Management (UM/QM) experience. Non-licensed Candidates: 5 years of Utilization Management/Quality Management (UM/QM) experience.

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