Job FamilyClinical, LicensedJob Brief
The Clinical and Quality Operations Manager will provide operational support to the clinical (Case Management and Utilization Management) and quality teams within the Southeast/Central Region.
ExemptABOUT THE POSITION
We are currently seeking a dynamic Clinical Quality Operations Manager
to join our Miami, FL team. This position is a remote position that can be based in the East Coast or Central. The Clinical and Quality Operations Manager
will provide operational support to the clinical (Case Management and Utilization Management) and quality teams within the Southeast/Central Region. In collaboration with the CQOD, the CQOM oversees the operational components of clinical and quality implementation activities; responds to requests requiring clinical operations support and is the primary business owner for clinical/quality audits.
This position has the flexibility of working remote in Florida.Position Responsibilities:
- Assists in the clinical and quality operation management of the region, serves as an expert resource and facilitates clinical & quality operations engagement between functional units i.e. quality, utilization management, and the case management and operational teams.
- In collaboration with the CQOD and Corporate Quality Accreditation, ensures ongoing compliance with accreditation (NCQA and URAC) standards.
- Serves as lead for clinical & quality audits including, but not limited to: internal audits related to accreditation; client or government agency audit requests; and overall triage of audits requests.
- Assists in the development and quality assurance reviews of contractual and ad hoc reporting requirements as needed. Reviews business questions and helps translate them into report requests and supports overall clinical reporting needs in the region.
- Acts as lead with the above cross regional teams to ensure adherence with accreditation, compliance and other contractual requirements. Activities may include workflow development, system enhancement, measurement review, and process improvement.
- Proposes clinical and/or quality solutions to business issues/problems utilizing appropriate analytic tools and business processes to ensure quality, cost effectiveness, timelines, with awareness of contractual and regulatory requirements/mandates.
- Works with the Regional Quality Director and team to coordinate quality control on clinical and quality deliverables, implementations, initiatives, and ad hoc requests.
: The position requires a minimum of a Bachelor's Degree in a related field (healthcare administration, behavioral sciences, business, project management) and preferably five years managed behavioral healthcare or related experience. A Master's degree in a healthcare field is desired but not required.Licensure
: Current, valid and unrestricted license required with proof on date of hire. Re-verification will take place no less than every 3 years.Relevant Work Experience:
• A minimum of 5-7 years combined direct behavioral health, supervisory and/or managed care experience required.Knowledge, Skills & Abilities
- A working knowledge of account management, customer relations and business management are essential
- Must possess Care Connects platform experience - not just received training, but actual routine use of all Connects systems
- The candidate must have a strong customer service orientation, excellent written and verbal communication skills, and experience using management information systems
- Knowledge and experience related to clinical services will be beneficial.
- Knowledge of CQI principles and ability to manage change
- Leadership skills and supervisory experience, including the ability to develop team performance.
Click below on "Apply for this Position"
to create a profile and apply for the position
Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
AAP Reporting Location:FL - Miami
ID (Req #):55443
FTE Status:Full Time
Schedule:8 am - 5 pm