Quality Management Specialist

Community Behavioral Health; Philadelphia (Philadelphia County); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Family Planning

Fertility Benefits

Adoption Benefits

403B Retirement Plan

PTO Days/Sick Days

Wellness Program

Employee Assistance Program

Health Insurance

Dental Insurance

Vision Insurance

Tuition Reimbursement

Commuter Benefits

Flexible Spending

Job summary

Community Behavioral Health is seeking a Quality Management Specialist to support daily operations of quality management processes, focusing on tracking, trending, and resolving significant incidents and quality concerns.

The role requires a Master’s degree in behavioral health, healthcare, or social sciences, plus 3+ years post-graduate experience including 2+ years in healthcare or quality management. Philadelphia residency is required, with no sponsorship offered.

Qualifications

• Master's degree in behavioral health, healthcare or social sciences.
• Minimum of 3 years post-graduate experience with at least 2 years in a health care or quality management setting.

Responsibilities

• Assist in tracking and trending all reported quality issues and produce trend analyses.
• Investigate clinical quality issues and complete required reports and documentation.
• Facilitate provider teaming meetings; conduct on-site provider visits; monitor Quality Improvement Plan submissions; prepare letters to providers.
• Assist with coding of Significant Incident Reports and determine level of follow-up warranted.

Skills

Microsoft Office

Communication skills

PA Act 68

Customer service

Training & facilitation

Interpersonal skills

DBH/DHS systems

Education

Master's degree in behavioral health / healthcare / social sciences

Job description

Job Description

CBH is a dynamic organization dedicated to providing access to high-quality, accountable care to improve the health and mental wellness of our members. As part of our growth, we are seeking a detail-oriented Quality Management Specialist to join our team.

CBH Job Level: 4

Benefits

• Family Planning, Fertility, Adoption Benefits
• 403B Retirement Plan
• PTO Days/Sick Days
• Wellness Program
• Employee Assistance Program
• Health, Dental, Vision Insurance
• Medical, Prescription Drug Insurance
• Tuition Reimbursement
• Commuter Benefits
• Flexible Spending

Position Overview

The Quality Management Specialist is responsible for assisting in the daily operation of the Quality Management processes. This entails tracking, trending and resolving significant incidents and quality concerns.

Essential Functions

• Assists in the tracking and trending of all reported quality issues and produces trend analysis.
• Investigates clinical quality issues and completes all required reports and related documentation.
• Facilitates provider teaming meetings. Conducts on-site provider visits, monitors Quality Improvement Plan submissions, and prepares required letters to providers.
• Assist with coding of all Significant Incident Reports and determining level of follow up warranted.

Position Requirements

• Education: Master's degree in behavioral health, healthcare or social sciences
• License/Certification: N/A
• Relevant Work Experience: Minimum of 3 years of post-graduate experience with at least 2 years of experience in a health care or quality management setting

Skills

• Proficient in Microsoft Office applications
• Excellent written and verbal communication skills
• Must have knowledge of PA Act 68, Appendix H and medical necessity criteria
• Customer service skills
• Training and facilitating skills
• Strong interpersonal skills
• Thorough knowledge of DBH and DHS systems and services

Philadelphia Residency Requirement

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.