We’re seeking Quality Manager to join our behavioral health team! In this role, you will work to promote the well-being of our members by assessing, collaborating with providers, monitoring and coordinating care.
Be a part of a mission driven company and work alongside passionate, caring and collaborative team members. If you are motivated to make a difference in people’s lives and want to play a role in transforming how healthcare is delivered, we invite you to check out the opportunity below and apply today.
The Quality Manager, Behavioral Health, is responsible and accountable for behavioral health (BH) quality improvement programs and initiatives which comply with state contractual obligations, regulatory requirements, and accreditation standards. Has the ability to evaluate project/program options and to make recommendations that meet overall business objectives. Works with the appropriate Plan leadership, material subcontractor and ACOs to ensure the success of the program and compliance with all contractual obligations.
Serves as Quality Management subject matter expert to the BH program and executes new strategic BH quality initiatives designed to support corporate goals including NCQA accreditation.
Provides day-to-day oversight of BH quality improvement needs in BMCHP products (e.g. MCO, ACO, SCO, and QHP) and all EQRO and quality requirements.
Coordinates and manages key aspects of regulatory and accreditation requirements (such as EQRO, NCQA) including:
Maintaining working knowledge of the BH related regulatory and accreditation standards
Working to meet and/or exceed the standards
Maintaining relevant documentation history
Completing regulatory documentation requirements
Developing detailed project plans and timelines for BH quality improvement project implementations and reviews.
Facilitating large multidisciplinary committees and smaller subgroups to create and implement interventions to meet project goals.
Generate supporting documentation for new project proposals, including internal and external reports.
Develops, implements, evaluates and documents interventions related to BH quality improvement goals and projects.
Partners with the New Hampshire BH quality improvement subject matter expert to align companywide BH quality improvement efforts.
Collaborates with Directors and Managers of BH Care Management regarding BH initiatives.
Ensures that the submissions for BH Performance Improvement Projects and other inquiries and required submissions are complete and timely.
Provides project management oversight for inter-departmental BH care processes, including goal tracking, coordination of communication, problem solving and on-going follow-up.
As appropriate, serves as liaison with providers, local educational and clinical agencies to support partnership opportunities developed to enhance the BH services provided to the Plan members.
Works with Chief Medical Officer, Senior Leadership and Medical Directors to achieve corporate BH initiatives and identify BH quality issues requiring further research, data collection, and preparation for review.
As appropriate, reviews, investigates and responds to BH clinical member grievances and BH adverse events in conjunction with Plan Medical Directors.
Provides BH support to staff in the Quality Department and other areas of the organization (e.g. Marketing).
Responsible for identification, approval, tracking, distribution and reporting of BH Clinical Practice Guidelines.
Participates in Massachusetts Quality Managers meetings with MassHealth and other MCOs and ACOs.
Consults with and provides support to the Accreditation Manager regarding NCQA standards and necessary documentation to maintain accreditation.
Develops and implements a process to utilize internal and external data sources, including quarterly reports, monthly management reports and population studies to identify interventions and potential topics for performance improvement projects initiatives.
Manages day-to-day quality processes including document preparation, literature reviews, and web–search requiring a high degree of independent decision-making.
Other duties as assigned.
Regular and reliable attendance is an essential function of the position.
Bachelor’s Degree in Social Work, Behavioral Health, Public Health or related field required.
Master’s Degree in Social Work, Behavioral Health, Public Health or related field strongly preferred.
5+ years behavioral health specific health care / managed care experience.
In depth knowledge of and experience with clinical BH quality management and related business goals and practices within related areas.
Experience with Medicaid/Medicare recipients and community services.
Prior Behavioral Health management experience.
Experience in project development and / or health policy.
Lean Six Sigma training.
Required Licensure, Certification or Conditions of Employment:
Competencies, Skills, and Attributes:
Demonstrated ability in leading / facilitating cross functional teams.
Demonstrated ability to successfully plan, organize and manage high impact projects.
Demonstrated ability to work independently and manage multiple projects simultaneously.
Effective collaborative and proven process improvement skills.
Strong analytical and problem solving skills.
Strong oral and written communication skills; ability to interact within all levels of the organization.
A strong working knowledge of Microsoft Office products.
Detail oriented, excellent proof reading and editing skills.
Internal Number: 2013713
About Boston Medical Center HealthNet Plan
Imagine working for an organization committed to making a difference. Founded in 1997 by Boston Medical Center (BMC), BMC HealthNet Plan supports the mission of BMC by providing medical care access to the underserved, disabled, elderly and other vulnerable populations.
BMC HealthNet Plan is a not-for-profit, market leading managed care organization that offers health insurance coverage to low-to-moderate income individuals in Massachusetts and New Hampshire (where it is known as Well Sense Health Plan). We offer health insurance plans in the Medicaid and commercial markets, and contract with health care providers and hospitals throughout Massachusetts and New Hampshire.
We employ over 600 individuals in Charlestown, Massachusetts and Manchester, New Hampshire. We offer our employees highly competitive benefits, compensation package and flexible work arrangement options. To demonstrate our commitment to serving the community, our employees are entitled to eight hours of paid volunteer time per year.
BMC HealthNet Plan employees are a diverse, talented workforce that work together to represent our values – member focus, stewardship, partnership, quality, inclusion and integrity.