Quality Reporting & Accreditation Specialist

Community Behavioral Health.•Philadelphia, PA

About The Position

The Quality Reporting and Accreditation Specialist serves as the primary project manager for CBH’s efforts to obtain and maintain National Committee for Quality Assurance (NCQA) Managed Behavioral Health Organization Accreditation, Certified Review Entity Certification, and HealthChoices Reporting. The role also assists the Director of Quality Improvement with monitoring, documenting, and reporting quality management activities. The specialist coordinates with accreditation and certification entities and the Office of Mental Health and Substance Abuse Services to support compliance with accreditation, certification, and HealthChoices requirements. The position prepares CBH for submissions and reviews, develops tools for identifying and mitigating quality risks, and compiles and maintains information and records for quality improvement, monitoring, accreditation, certification, and audits. The specialist works with internal departments on metrics and action plans, recommends improvements or remediation to CBH Officers and the Quality Improvement Committee, helps report suspected fraud, waste, or abuse, and coordinates communications about quality activities with internal and external stakeholders. The successful candidate must be a current Philadelphia resident or become one within six months of hire. Applicants must be legally authorized to work in the United States without current or future sponsorship.

Requirements

Master’s degree in behavioral health, healthcare, public administration, or social sciences.
Minimum of 3 years of post-graduate experience.
Certified Professional in Healthcare Quality (CPHQ) certification required within 1 year of hire.
Mid- to high-level proficiency with Microsoft Office applications.
Excellent written and verbal communication skills.
Knowledge of HealthChoices regulations and requirements.
Knowledge of NCQA requirements.
Detail-oriented and highly organized.
Knowledge of quality management, assurance, and improvement principles.
Ability to work effectively with all levels of staff.
Ability to manage ongoing projects and prioritize appropriately to meet deadlines.
Must be a current Philadelphia resident or become a resident within six months of hire.
Must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Nice To Haves

Certified Professional in Healthcare Quality (CPHQ) certification.
Project Management Professional (PMP) certification.

Responsibilities

Serve as project manager for coordination and collaboration with accreditation and certification entities and the Office of Mental Health and Substance Abuse Services to ensure compliance with accreditation, certification, and HealthChoices requirements.
Prepare CBH for accreditation, certification, and HealthChoices submissions and reviews.
Develop tools to determine exposure to quality risks and identify opportunities to manage and mitigate those risks.
Compile information for quality improvement and monitoring activities and accreditation/certification for internal use and external audits, and maintain relevant records.
Work with internal departments to develop metrics for program objectives and monitor action plans relating to compliance and quality improvement.
Make recommendations to CBH Officers and the Quality Improvement Committee for improvements or remediation to ensure compliance.
Help assure internal and external program integrity by identifying and reporting suspected provider or employee fraud, waste, or abuse.
Coordinate communications about quality improvement and monitoring activities with internal and external stakeholders.
Assist the Director of Quality Improvement in monitoring, documenting, and reporting quality management activities.