Quality Management Specialist

Community Behavioral Health.•Philadelphia, PA

About The Position

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. 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.

Requirements

Education: Master’s degree in behavioral health, healthcare or social sciences
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
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
The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.
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.

Responsibilities

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.