Cphq – HCQM Clinical Quality Management Analyst Sr BH
| Company | Elevance Health |
|---|---|
| Location | Iselin, Woodbridge Township, NJ, USA |
| Salary | $73120 – $126132 |
| Type | Full-Time |
| Degrees | Bachelor’s, Master’s |
| Experience Level | Mid Level |
Requirements
- Requires a BA/BS in a behavioral health related field
- Minimum of 3 years behavioral health clinical and managed care or clinical quality improvement experience
- Any combination of education and experience which would provide an equivalent background
Responsibilities
- Conducts behavioral health provider on-site audits researching behavioral health provider clinical quality issues
- Implementation of quality measures of network adequacy
- Implementation of processes designed to improve access to care for special needs populations
- Resolving, tracking, and trending quality of care complaints
- Prepares corrective action plans in response to oversight body’s request
- Conducts behavioral health audits of QM processes and files
- Writes policies and procedures
- Assists with development of behavioral health provider manuals, audit tools, and guidelines
- Coordinates collection and organization of information and documents in preparation for regulatory audits
- Participates in development and design of audit tools, policies and procedures, and behavioral health provider manuals
- Completes quarterly Quality Management (QM) coalition reports for submission to regulatory bodies
- Ensuring that systems and procedures exist that assess provider satisfaction
- Conducts new hire orientation and on-the-job training sessions
- Travels to worksite and other locations as necessary
Preferred Qualifications
- 3 years of experience in Quality Management/Quality Improvement highly preferred
- Certified Professional in Healthcare Quality (CPHQ) by the National Association for Healthcare Quality, or be Certified in Healthcare Quality and Management (HCQM) by the American Board of Quality Assurance and Utilization Review Physicians
- MS/MA degree preferred
- Experience working with MCO or the State of New Jersey
- Experience working with BH providers, experience analyzing data, reporting writing, and interpretation of policies and procedures