JOB DESCRIPTION: The Director of Quality Improvement and Compliance is quality leader for the organization and is charged with the oversight and implementation of clinical and quality initiatives at BCBHM. The Director of QI & C will work closely with the BCBHM Management Team in establishing and implementing management action strategies. As the organization’s Compliance Officer, the Director of QI&C is responsible for ensuring organizational compliance with all external mandates including state, federal and accreditation requirements. This position is responsible for leading the organization’s internal compliance program including education, training and technical assistance to staff. The Director of QI & C is also charged with assessing organizational undertakings to ensure compliance with applicable external oversight requirements. The Director of QI & C will have excellent oral, written, interpersonal and organizational skills, and demonstrate a facility with data interpretation both in written and graphical format.
In conjunction with the Vice President of Operations, focus on improving healthcare outcomes through the development of innovative programming for the populations served by BCBHM.
Collaboration with health plan quality leaders on strategies to improve the integration of medical, pharmacy and behavioral health services.
Overall accountability for maintaining compliance and accreditation with NCQA and URAC UM and CM standards.
Overall accountability for HEDIS/QARR reporting to plans who delegate this function.
Chairs the Quality Improvement Committee(QIC) and in collaboration with the Management Team, monitors, designs and implements the annual QM & I Program Description, the annual Work Plan and selected annual Quality Improvement Projects (QIPs).
In collaboration with the QI Executive Assistant evaluates the QM & I Program and Work Plan at least annually.
Through review of key indicators, plans and implements improvement strategies with selected staff when opportunities are identified.
Acts as lead on implementation of quality activities for new contracts and business opportunities.
Interfaces with external customers regarding Beacon’s performance.
Trains staff on CQI tools and techniques to ensure that quality is continually integrated in the organization.
Oversees retrospective clinical records review processes, sentinel events, complaints and grievances, HIPAA incidents, claims fraud investigations and annual provider treatment record audits.
Ensuring organizational compliance with all external regulating entities.
Serves as a resource for internal and external compliance inquiries
Maintains an organizational compliance program (including education and training as necessary)
Works in conjunction with the Management Team on implementing all regulatory changes
Maintain ongoing work plan related to compliance activities and organizational prioritization
Acts as Lead for all delegation and accreditation audits and, when necessary, corrective action processes.
Other duties as assigned.
A minimum of BS/BA in health care related field. Experience in health care, CQI experience, knowledge of NCQA MBHO standards and URAC HUM and CM standards preferred, outcome and statistical process/analysis required. Experience with using data to manage or problem solve required. Word processing and spreadsheet experience required. Ability to present data multi-modally, ie. written report, graphic display and statistical.
Comprehensive Behavioral Health Management - 17 months ago