Quality Improvement Coordinator - Behavioral Health
About The Position
The Quality Improvement Coordinator analyzes, develops, and monitors clinical quality improvement activities to ensure compliance with customer expectations and leads clinical quality initiatives in behavioral health. The role develops and implements the behavioral health quality program description, work plan goals—including applicable HEDIS measures—and program evaluation documents. It also leads Behavioral Health Performance Improvement Projects (PIPs). The coordinator reviews clinical information for appeals to determine medical necessity, prepares cases for appeals that do not meet medical necessity, and serves as a liaison for appeals and fair hearings. The role investigates and resolves behavioral health quality-of-care complaints and grievances, and maintains files, logs, documentation, and communications in accordance with NCQA and state standards, regulations, and timelines. Other duties may be assigned, and the employee must comply with all policies and standards.
Requirements
- Associate's degree in Nursing or another related field of study.
- At least 2 years of experience in Clinical Nursing or Behavioral Health.
- At least 1 year of experience in Quality, Managed Care, or Healthcare Administration.
- Registered Nurse (RN) certification, Licensed Mental Health Professional (LMHC), or Licensed Professional Counselor (LPC) license required.
Nice To Haves
- Experience in the behavioral healthcare field preferred.
Responsibilities
- Analyze, develop, and monitor clinical quality improvement activities to ensure compliance with customer expectations.
- Lead clinical quality initiatives and Behavioral Health Performance Improvement Projects (PIPs).
- Develop and implement the behavioral health quality program description, work plan goals, applicable HEDIS measures, and program evaluation documents.
- Review clinical information for appeals to determine medical necessity of services.
- Prepare cases for appeals that do not meet medical necessity.
- Act as the liaison for appeals and fair hearings.
- Maintain files, logs, documentation, and communications in accordance with NCQA and state standards, regulations, and timelines.
- Investigate and resolve behavioral health quality-of-care complaints and grievances.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work, with remote, hybrid, field, or office work schedules
- Total compensation may include additional incentives
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
