PacificSource Health Plans Behavioral Health Quality Improvement Specialist in Bend, Oregon
Responsible for supporting the Behavioral Health (BH) Quality management program. This includes, but is not limited to, critical incident report information collection and compilation, monitoring provider reports, oversight of the Choice Model Contract, oversight of Wraparound providers, contributing to the development and implementation of quality improvement plans, and collaborating with the health services team on matters associated with behavioral health quality.
Distribute provider self-audits and monitor for completion. Compile results for review by BH Clinical Quality Improvement Coordinators.
Collect behavioral health critical incident reports. Submit documentation requests to providers and compile all information. Track timeliness of reporting per policy requirement.
Responsible for implementation, oversight, monitoring and reporting of the Choice Model Contract to meet OHA contractual standards and compliance.
Monitoring and oversight of the Wraparound service providers to ensure OHA standards are met.
Align program with PacificSource strategic goals and major initiatives. Coordinate work with key stakeholders including providers, community organizations, and state workgroups to ensure contract and other deliverables are met.
Monitor the submission of provider reports and ensure compliance with reporting requirements. Review and compile reported data for submission to internal committees.
Collaborate with BH Clinical Quality Improvement Coordinators and Program Managers on key initiatives aimed at increasing quality performance and program goals.
Gather needed information for internal and external audits to meet federal and state requirements.
Serve as a resource for internal staff, community partners, and provider partners on all quality activities.
Collaborate with other programs in the development and implementation of provider trainings.
Take part in the development and implementation of quality improvement projects and programs to ensure compliance with CMS program regulations and regulations from the Oregon Health Authority.
Meet department and company performance and attendance expectations.
Participate in and support project teams led by other departments and provide necessary input to support the goals of colleagues
Perform other duties as assigned.
Work Experience:Three years of experience in healthcare or behavioral health with varied clinical focus required. Experience in auditing, program development, report writing, and application of state or federal regulations preferred.
Education, Certificates, Licenses:Bachelor’s degree in Behavioral Health or other related field required.
Knowledge:Knowledge and understanding of procedure codes, including ICD-10, CPT Codes and health insurance. Knowledge Medicaid a regulations. Knowledge of quality improvement methodology. Ability to develop, review, and evaluate utilization reports.Strong writing, analytical, and problem solving skills.Organizational skills with solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Ability to work independently with minimal supervision.
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customers’ experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our communities-internal and external.
We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.
Environment:Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately5%of the time.
Physical Requirements:Stoop and bend.Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
Disclaimer:This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.