Quality Management Specialist

Beacon Health Strategies   •  

Rocky Hill, CT

Industry: Healthcare

  •  

5 - 7 years

Posted 59 days ago

This job is no longer available.

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Quality Management Specialist II to join our team at our office in Rocky Hill. The Quality Management Specialist II will be responsible for Reviewing provider treatment records as part of the CT BHP Record Review Program for the purpose of ensuring quality of care, verifying documentation to support information received during medical necessity reviews, and confirming conformance with treatment record documentation standards. Participating in the Quality of Care Committee and plays an active part in coordinating the tasks involved in keeping that committee functioning at a high level. Participating in audits of CT BHP clinical staff documentation for thoroughness.

Position Responsibilities:

  • Plays a lead role in maintaining the Quality of Care Committee including maintenance of files associated with the committee and meeting minutes.
  • Review provider records submitted to CT BHP based on potential quality of care concern. Elevate for medical director review as appropriate.
  • Maintains a working knowledge of CT BHP documentation standards and requirements.
  • Conduct internal documentation audits of CT BHP clinical staff documentation.
  • Assists in the identification and notification of providers who will participate in the treatment record review process. Arranges all necessary details to begin on site review and communicates with providers as necessary.

Education: Master’s LevelClinician

Licensure: Licensed for appropriate discipline

Relevant Work Experience: 5 years of professional experience in the mental health /substance abuse field. General knowledge of managed care, quality management, and utilization management principles preferred. Good writing, analytical, and verbal presentation skills.

Knowledge, Skills & Abilities:

  • Basic computer skills
  • Knowledge of Microsoft Office Products.

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