Clinical Quality Clinician (Remote)

Vaya Health

7d•Remote

About The Position

The Clinical Quality Clinician will assess the quality of member care and improvement of clinical quality outcomes. This position applies behavioral health knowledge along with analytical skills to effectively and efficiently identify and develop quality activities aiming to improve performance metrics. The Clinical Quality Clinician works within a team and utilizes identified best practices to provide improvement opportunities and develop interventions to impact member outcomes.

Requirements

Knowledge of rules, regulations and contractual standards related to behavioral health and medical performance methods and best practices. Ability to identify areas to improve member outcomes. Develop and implement plans of correction and monitor the impact of those plans.
Knowledge of the treatment/service needs of the members served, and skills to assess strengths and needs. Knowledge of treatment plan development with medical/clinical service implementation is imperative.
Thorough knowledge of psychometrics and of various psychological assessment instruments, their application, administration, and interpretation.
Working knowledge of DSM-IV (or current Diagnostic and Statistics Manual of Mental Disorders (DSM), its use, and the process of diagnosis.
•Clinical knowledge of documentation, clinical protocols, and provision of Intellectual/Developmental •Disabilities and/or co-occurring mental illness.
•Administrative knowledge of the service definitions and waivers operated by the State of NC.
Detail oriented, ability to organize and manage multiple tasks independently, ability to be flexible, adaptable, accountable, and self-governed are essential.
Problem solving, negation and conflict resolution skills are essential to balance the needs of internal and external customers.
Exemplify a solution focused attitude with the flexibility to change focus of activities to meet changing priorities.
Extensive oral and written communication with providers, members, state regulatory agencies and other internal/external stakeholders.
Excellent decision-making abilities based upon relevant facts and established evidence based processes to determine the appropriate course of action during quality reviews and subsequent follow up.
Exceptional interpersonal skills, ability to work with a team as well as autonomously, exercising sound judgment and problem resolution skills.
Ability to establish respectful relationships/partnerships with persons of diverse ethnicities and abilities.
Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
Knowledge of CPT, ICD and HCPCS coding
Master’s degree and two (2) years (post degree) experience in the field of mental health, intellectual and developmental disabilities, or substance use is required.
Current unrestricted Active North Carolina Clinical License (LCSW,LCMHC, and/or LCAS) required
CLEAR/NCIT Basic Certified Investigator (CI) (should be obtained during first nine months of employment)

Nice To Haves

At least one (1) year providing clinical services in a substance use treatment facility (Methadone/Suboxone clinic) is preferred.
Two (2) years experience with Healthcare/Health Plan preferred.
Experience completing compliance reviews and preparing written reports preferred.
Experience in quality improvement, analysis, and development in public health or related area preferred.

Responsibilities

Assist with the development and completion of processes and protocols which aim to improve member outcomes.
Collaborate with leadership to develop tools and programs which support the organization’s goals.
Complete desk top monitoring activities to assess quality benchmarks using best practice, compliance with rules, regulations, service definitions, while maintaining the quality and integrity of the review process.
Generate Reports of Findings to address outcomes of a review and quality issues identified.
Implement monitoring systems to measure the performance of the contracted providers in the Vaya Health Network and member outcomes.
Assist with the development of best practice interventions to address and identify treatment gaps within the Vaya Health Network of contracted providers.
Complete tracking and monitoring systems specified by regulatory requirements, accreditation standards, policies and procedures, protocols, and contractual requirements.
Provide support to the development of robust quality providers in the Vaya service area.
Provide support to all providers participating in the Clinical Quality Team review process.
Collaborate with internal and external stakeholders to develop quality solutions as improvement opportunities are identified.
Participate in inter-rater activities, provide consultation, and provide back-up to other quality functions.
Provide QM representation on cross-functional committees.