The Clinical Quality Assurance Advisor partners with the North Carolina HPS and VCC Clinical Referral Line Management Team to evaluate CCM clinical and quality performance by monitoring calls and correspondence, daily. This individual will ensure the delivery of excellent service to internal and external customers across multiple clients and products. Through exceptional interpersonal and communication skills, effective leadership, planning, process management and information analysis, this individual will continually promote a customer focused environment. This position enhances customer loyalty by ensuring that managers and supervisors are continually apprised of critical service quality issues, staff receives appropriate training and performance feedback and management receives appropriate recommendations regarding staff development, etc.
1. Monitors, evaluates and documents member or provider calls for designated staff to ensure staff responses meet ValueOptions® clinical and quality audit standards, and provides managers, supervisors and clinical care managers with call coaching quality data. Partners with the management team to ensure frequent performance and developmental feedback are provided to the HPS and VCC Clinical Referral Line staff.
2. Compiles/reports monitoring evaluation data and presents call coaching sessions. Provides CCM’s with an action plan for process improvement, and if needed collaborates with the management team in the corrective action process by gathering documentation regarding noncompliance in meeting required standards. Contributes to performance improvement plans and participates in discussions, up to and including termination.
3. Ensure processes are in place to support compliance with all state and federal laws (HIPAA), regulatory requirements, accrediting agencies (NCQA and URAC) as well as ValueOptions® clinical criteria and policies and procedures.
4. Compiles and presents summary level call coaching and efficiency data which becomes part of each CCM’s performance review. Assures integrity and confidentiality of call monitoring documentation and evaluates/develops monitoring tools to support efficiency and effectiveness in the call monitoring process.
5. Audits the timeliness and accuracy of any contractual follow up inquiries made by HPS, VASC, and VCC Clinical Referral Line staff. Measures the ability of CCM’s to successfully meet all client performance expectations and presents final assessments/employment recommendations to management.
6. Identifies improvements or training opportunities and develops/presents quality improvement training materials to improve overall service quality. Identifies trends in inquiry monitoring and applies corrective actions as necessary to meet business needs. Ensures follow through with CCM’s.
7. Develops ideas for performance improvement, service delivery, and cross-functional initiatives that contribute to department success.
8. Collaborates with the management team on new client implementation activities, including development/presentation of training materials, to ensure all home service center and client performance expectations are met.
Minimum Qualifications: Requires solid knowledge base and working knowledge of mental health systems with clear understanding of psychiatric clinical case management and Employee Assistance Programs. Requires effective management and interpersonal skills. Must be able to articulate programs verbally and in writing as necessary.
Education: Registered Nurse with Bachelor’s Degree and/or Master’s Degree in Social Work or one of the other core mental health disciplines.
Licensures: Current, valid and unrestricted license in a State or territory of the United States in a mental health field (RN, Ph.D., LCSW/ACSW, LLP, MHC, LPC, etc.). Current licensure must be maintained in the state where employed. Additionally, some client contracts will also require current licensure in the state in which their membership or consumer base resides.
Relevant Work Experience: A minimum of five years post graduate clinical/administrative experience, supervisory or team lead experience preferred.
Value Options - 18 months ago
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