Quality Improvement Coordinator - Behavioral Health Job at LA Healthcare Connections
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
This is a fully remote position. Applicants must reside in LA and have licensure as one of the following: LPC, LCSW, LAC, or LMFT. This position will ensure contracted specialized behavioral health providers meet compliance with national as well as federal standards and clinical practice guidelines through medical record abstraction and review. You will Perform monitoring activities through member record reviews to ensure quality of services being rendered. Perform outreach activities to providers to obtain records and to members to complete satisfaction surveys. Varied activities can include: on-site visits to provider locations, corrective action planning activities with providers, team projects, Quality initiatives, etc.
Position Purpose: Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, prepare reviews for cases, act as the liaison for appeals and fair hearings.
Position Responsibilities:
Develop and implement the quality program description, work plan goals including applicable Healthcare Effectiveness Data and Information Set (HEDIS) measures and program evaluation (trilogy documents) for behavioral health
Lead Behavioral Health Performance Improvement Projects (PIPS)
Review clinical information for appeals to determine medical necessity
Prepare cases for appeals that do not meet medical necessity
Maintain files, logs, documentation including communication in accordance with National Committee for Quality Assurance (NCQA) and State standards and regulations including timelines
Investigate and resolve behavioral health quality of care complaints and grievances
Education/Experience: Associate’s degree in Nursing or other related field of study. 2+ years’ experience in Clinical Nursing or Behavioral Health and 1+ year of experience in Quality, Managed Care or Healthcare Administration required. Experience in Behavioral Healthcare field preferred.
Licenses/Certifications: Registered Nurse (RN) certification, Licensed Mental Health Professional (LMHC), or Licensed Professional Counselor (LPC) required.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Please Note :
bankofmontserrat.ms is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, bankofmontserrat.ms provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.
This is a fully remote position. Applicants must reside in LA and have licensure as one of the following: LPC, LCSW, LAC, or LMFT. This position will ensure contracted specialized behavioral health providers meet compliance with national as well as federal standards and clinical practice guidelines through medical record abstraction and review. You will Perform monitoring activities through member record reviews to ensure quality of services being rendered. Perform outreach activities to providers to obtain records and to members to complete satisfaction surveys. Varied activities can include: on-site visits to provider locations, corrective action planning activities with providers, team projects, Quality initiatives, etc.
Position Purpose: Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, prepare reviews for cases, act as the liaison for appeals and fair hearings.
Position Responsibilities:
Develop and implement the quality program description, work plan goals including applicable Healthcare Effectiveness Data and Information Set (HEDIS) measures and program evaluation (trilogy documents) for behavioral health
Lead Behavioral Health Performance Improvement Projects (PIPS)
Review clinical information for appeals to determine medical necessity
Prepare cases for appeals that do not meet medical necessity
Maintain files, logs, documentation including communication in accordance with National Committee for Quality Assurance (NCQA) and State standards and regulations including timelines
Investigate and resolve behavioral health quality of care complaints and grievances
Education/Experience: Associate’s degree in Nursing or other related field of study. 2+ years’ experience in Clinical Nursing or Behavioral Health and 1+ year of experience in Quality, Managed Care or Healthcare Administration required. Experience in Behavioral Healthcare field preferred.
Licenses/Certifications: Registered Nurse (RN) certification, Licensed Mental Health Professional (LMHC), or Licensed Professional Counselor (LPC) required.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Please Note :
bankofmontserrat.ms is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, bankofmontserrat.ms provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.