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Job Location: Atlanta, GA
The Quality Management Specialist II will be responsible for conducting quality reviews on-site at provider locations. Candidates must be able to travel extensively within the state in assigned geographic areas
ABOUT THE POSITION
We are currently seeking a dynamic Quality Management Specialist II to join our team at our office in Atlanta, GA. The Quality Management Specialist II will be responsible for conducting quality reviews on-site at provider locations. Candidates must be able to travel extensively within the state in assigned geographic areas.
- Conduct contract-required quality records reviews to ensure compliance with policies, state and federal standards and client performance standards and participate in other monitoring assignments as required. (e.g. Technical Assistance Consultation/ Claims Documentation Reviews).
- Work with clinical, provider relations and QM Departments to establish and maintain a process for regular treatment record reviews; conduct treatment record audits, compile and report results.
- Coordinate and communicate provider monitoring and improvement activities and results within QM Department as well as inter-departmentally. Support service center department directors in developing processes for oversight of high-risk areas associated with delegation, contract and provider monitoring requirements.
- Identify trends and patterns of deficiencies within the medical; evaluate results, identify and communicate areas for improvement within the system.
- Conduct Individual and Staff interviews, compile and report results.
- Prepares written reports on QI activities that describe results, strengths, opportunities for improvement and recommendations.
- Prepares and presents trainings to providers, as needed.
- Maintains confidentiality, ethical and professional standards, personal standards of cultural competency, and leads by example.
- Performs other duties as assigned.
Education: Master's degree in health related field or 5 years of experience in a behavioral health related field.
Licensure: Licensure in a mental health related field (Ph.D., RN, LCSW, LPC, LMFT, LMSW, etc.), RN preferred.
Relevant Work Experience:
- Minimum three (3) years' work experience in Quality Management or healthcare field. Knowledge of QI philosophy and techniques and state, federal guidelines and regulations preferred.
- Experience in behavioral health. Requires experience with treatment record documentation or some clinical or quality-related knowledge of treatment record documentation requirements, ability to understand contract and other regulatory requirements. Knowledge of the Georgia DBHDD Provider Manual preferred. Experience conducting audits, training and basic knowledge of procedure codes, strongly preferred.
- This position required highly developed organizational and verbal/written communication skills. In addition, this position must be able to demonstrate initiative; ability to interact with individuals at all levels of the organization and external sources (i.e., sub-contracted providers, stakeholders and state and/or federal agencies) and is pro-active in problem resolution. The individual for this position must be able to manage multiple priorities and work effectively in a fast-paced environment.
Knowledge, Skills & Abilities:
- Excellent computer skills
- Strong analytical and problem solving skills
- Strong written and verbal communication skills
- Detail oriented and able to work independently
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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled
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