Behavioral Health Quality & Risk Coordinator

Commonwealth of Pennsylvania; Pennsylvania; Hybrid; USD 60,000 - 80,000; Full time

Job summary

The Commonwealth of Pennsylvania in Harrisburg is seeking a Quality Assurance Risk Management Coordinator within the Department of Human Services to evaluate programs and improve the quality of behavioral health services. You will collaborate with partners to ensure strong, reliable care and better outcomes for communities statewide.

Primary duties include reviewing contractor and managed care operations for compliance with federal and state rules, evaluating performance data, and leading audits

Qualifications

• One year as a Quality Assurance/Risk Management Specialist or three years in a health care setting with a bachelor's degree.
• Experience evaluating programs, data, and compliance in behavioral health.
• Ability to analyze policy changes and their impact on services.

Responsibilities

• Program Reviews: Examine contractor and managed care operations for compliance with rules.
• Data Evaluation: Assess documents to ensure standards and benchmarks are met.
• Compliance Monitoring: Review service decisions for medical necessity and clarity.
• Onsite Audits: Lead audits to evaluate access, quality, and risk in behavioral health.
• Collaboration: Work with partners on quality reviews and clinical practices.
• Policy Analysis: Interpret legislative/regulatory changes for impact on services.

Skills

Quality Assurance

Risk Management

Program Evaluation

Data Analysis

Policy Analysis

Education

Bachelor's degree

Job description

The Commonwealth of Pennsylvania in Harrisburg is seeking a Quality Assurance Risk Management Coordinator within the Department of Human Services to evaluate programs and improve the quality of behavioral health services. You will collaborate with partners to ensure strong, reliable care and better outcomes for communities statewide.

Primary duties include reviewing contractor and managed care operations for compliance with federal and state rules, evaluating performance data, and leading audits