Complaint/Risk Analyst

  • Beacon Health Options
  • SEVEN FIELDS, PA
  • Sep 23, 2018
Medical

Job Description



Location
PA: Seven Fields

Job Family
Clinical, Licensed

Job Brief
We are currently seeking a dynamic Complaint/Risk Analyst to join our team at our office in Rocky Hill, CT!

Exempt

ABOUT THE POSITION

We are currently seeking a dynamic Complaint/Risk Analyst to join our team at our office in Rocky Hill, CT! The Complaint/Risk Analyst is a professional level clinical (license required) position that supports risk management functions. The position is primarily responsible for investigating and reporting on all complaints; it requires some participation in a range of quality management activities including adverse incident and quality of care investigations and reporting, audits, data collection, and analysis. The Complaint Analyst investigates all complaints, collects supporting documentation, presents findings to committee and contacts complainants with resolutions. Provides education to both consumers and providers by answering pertinent questions/concerns regarding Act 68 complaint processes. Participates in design, development, and implementation of quality improvement initiatives pertaining to risk management. Conducts medical record reviews and analysis of data to evaluate clinical care and provider performance.

Position Responsibilities:
  1. Review member and administrative complaints as defined by contractual requirements including but not limited to:
  • Conducting an in-office or on-site investigation including, but not limited to, the interview of involved staff and inspection of the physical plant, related to the occurrence of a complaint;
  • Interview of complainant
  • A review of the patient's chart
  • Summarization of the findings
  • Monitoring provider compliance with corrective action plan; and
  • Presentation of results of investigation to appropriate committee
  • Follow-up from QMC committee or subcommittee recommendations
  1. Maintain records of complaints, investigation and supporting documentation to ensure responses to required timelines.
  2. Creation of detailed, member specific, individualized resolution letters.
  3. Report specific occurrences, trends and opportunity for improvement to the Quality Manager and Director
  1. Ensure that the complaint process complies with all relevant policies and regulations including those put forth by Beacon Health Options and all contractual requirements.
  2. Collaborate as required with senior management and legal counsel in the strategic response to specific complaints.
  1. Provide ongoing support for preparation to include Contract Readiness Reviews, and all OHMSAS and External Quality Review reporting standards.
  2. Assist in the oversight of organization-wide performance improvement activities. Assist with preparing written assessment reports that describe results, operational strengths, opportunities for improvement and recommendations.
  1. Develop and improve workflows and forms as necessary to ensure the satisfactory operation of the complaint investigation and reporting process. Assist in updating policies and procedure documentation as necessary.
  1. Provide support related to local policy implementation, training and workflows. This includes the local Complaint investigation activities, policy, and procedure.
  1. Oversee Quality of Care concerns and adverse incident investigation and resolution, including reviewing clinical records and presenting findings to Quality of Care Committee and preparing aggregate quality of care and adverse incident reports to identify system-wide or provider specific opportunities.
  1. Participate in QM committee meetings, including QMC, Quality of Care and QM sub-committees
  1. Participate in annual QM Program document development including QM Program Description, QM Work Plan, and QM Program Evaluation.

Position Requirements:

Education: This position requires a Master's Degree from an accredited school of social work or psychology or a Masters in Counseling or bachelor degree in nursing.

Licensures: Licensure is required from the field of social work, nursing (BSN), or Counseling (LPC) or other related mental health field.

Relevant Work Experience: Individual is required to have at least two years of clinical experience. Experience in a community mental health setting is strongly desired.

TO APPLY

Click below on "Apply for this Position" to create a profile and apply for the position

Beacon Health Strategies, LLC. a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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PM16

AAP Reporting Location:

PA - Trafford

ID (Req #):

55572

FTE Status:

Full Time

Schedule:

Monday Friday 830-5 pm

PI104503767