Behavioral Health Clinical Quality Improvement Coordinator

Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
This position is responsible for design, implementation, and oversight of Behavioral Health (BH) Quality Management program and activities, in collaboration with the Behavioral Health Manager and Quality Manager. This position is responsible for all aspects of the BH Quality Management program including but not limited to; development of quality assurance and improvement plans, internal and external quality auditing and contract monitoring assuring compliance with State and Federal regulatory standards, contractual requirements and delivery of high quality clinical care. The position also analyzes effectiveness of programs, clinical services and processes and implements changes for improvement to PacificSource Community Solutions (PSCS) Behavioral Health programs and services.
Essential Responsibilities:

• Develop the BH Quality Work Plan in collaboration with subcontracted delegated entities and providers incorporating assurance activities and improvement initiatives.
• Analyze BH quarterly Quality Work Plan reports and presents results and written analysis to the Quality Assurance and Utilization Management Committee.
• Develop and manage a continuous contract auditing and monitoring process for BH services and programs.
• Develop auditing, monitoring tools, performance measures/indicators and reporting processes that are relevant to contracts and consistent with state and federal regulations.
• Continuously monitor compliance and performance standards mandated by our State contract and other regulatory bodies as those pertain to PSCS BH services and programs.
• Develop, implement and monitor BH corrective action plans in response to internal and external audits.
• Ensure timely submission and execution of corrective actions resulting in compliance with State and Federal regulations and contract requirements.
• Continuously monitor compliance and performance standards of our subcontracted delegated entities and providers.
• Ensure subcontractors and providers submit and execute corrective action plans as required.
• Design, write, and present specialized quality reports.
• Manage maintenance of BH policies, procedures, and documents related to BH quality management and compliance.
• Ensure annual review timelines are met and policies and procedures are relevant, up to date and compliant.

Supporting Responsibilities:

• Answer PSCS BH contract interpretation questions from other departments, physicians and providers of medical services and supplies.
• Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients.
• Work with department leadership in responding to inquiries or complaints to the Insurance Commission, preparing reports for other review functions, and addressing grievances and appeals.
• Coordinate business activities by maintaining collaborative partnerships with key departments.
• Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
• Meet department and company performance and attendance expectations.
• Lead and/or support Quality Improvement activities, designated committees, and/or task forces to ensure the delivery of quality, cost-efficient, high quality member care. Build partnerships by interfacing with community stakeholders and provider community to promote all aspects of high quality clinical care.
• Represent PSCS in quality capacity at community, statewide and regional meetings to create and implement Quality Improvement policy, projects and interventions.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned.

Work Experience:
A minimum of 3 years Behavioral Health experience required. Psychiatric and substance abuse health care preferred. Quality management/assurance/improvement, project development, management and implementation, and/or regulatory compliance auditing required.
Education, Certificates, Licenses:
Master's degree required in counseling, psychology, social work, or related field or a Registered Nurse with Behavioral Health care experience. License/certification in Behavioral Health related field preferred.
Knowledge:
Knowledge of Behavioral Health State Medicaid and Medicare regulations. Strong analytical and problem solving skills. Proficiency with computer information systems and software. Knowledge of basic statistics and research methods.
Competencies:
Building Trust
Building a Successful Team
Aligning Performance for Success
Building Partnerships
Customer Focus
Continuous Improvement
Decision Making
Facilitating Change
Leveraging Diversity
Driving for Results
Environment:
Work inside in a general office setting with ergonomically configured equipment. Evening meeting attendance is required at least monthly. Occasional overnight travel.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.