Join a team where your community is our first priority. At Community Care Behavioral Health (CCBH), we're committed to giving your neighbors the quality of life that they deserve. A proud part of the UPMC Insurance Services Division, we provide members with the behavioral health treatment they need for better health and a higher quality of life, including treatment for mental health conditions, drug or alcohol addiction, and developmental disabilities.
Community Care Behavioral Health partners with MetroPlus Health Plan to provide care to its members in the New York City area. With opportunities ranging from clinical to customer service, and everything in between, we're looking for highly motivated and compassionate individuals to join our diverse team where passion is nurtured and rewarded.
We are hiring a team of full-time Quality Management Clinicians to support the Quality Department within Community Care Behavioral Health Organization (Community Care) / MetroPlus business unit. This will be a Monday through Friday daylight schedule. Travel to treatment facilities and provider sites to conduct record reviews, site visits and other quality management activities will be required. The Quality Management Clinicians will be based out of the New York City office location.
Quality Management Clinicians are responsible for performing functions related to quality management and improvement, in compliance with NCQA, HEDIS, URAC, QARR and the New York State Department of Health quality assurance regulations.
* Responsible for performing targeted, clinical audits and focus studies. * Responsible for preparing monthly and quarterly quality improvement reports to the Board. Responsible for participating in updating the QM Plan. * Responsible for assisting with training responsibilities for providers, Members, and staff on various issues as assigned by the Senior Director of Quality Management. * Responsible for professional and staff development plan. * Responsible for assisting with preparation for NCQA,QARR, HEDIS URAC, and other off site and onsite visits. * Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff/committees, and aggregating the data on a monthly basis. * Responsible for logging in, tracking, monitoring, and reporting individual and aggregate complaints and grievances to the Senior Director of Quality Management and other leadership staff members as appropriate. Prepares formal reports and tracks timing of various levels of complaint and grievance for further action. * Responsible for specified data collection related to all functional departments of Community Care. Responsible for identifying trends related to product and participating providers. * Responsible for participating in projects as designated by other management staff, such as the Chief Medical Officer and VP of Medical Affairs.
* Licensed Registered Nurse (BSN preferred) or Masters Degree (licensure preferred). * 3 years clinical experience. * Experience in Quality Management procedures/processes preferred. * Knowledge of URAC, NCQA, QARR and HEDIS standards referred. * Experience in managed care preferred. * Excellent organizational skills. * Experience in report writing, Microsoft Access, Microsoft Excel, collection and organization of large quantities of data. * Ability to maintain effective professional liaison with all levels of staff, including professional and institutional providers of care. * Independent problem solving related to job responsibilities based on knowledge of quality standards, clinically pertinent issues related to product and population served, and the operating practices of this organization. * Ability to identify trends or problem areas. * Demonstrates clinical knowledge of behavioral health related issues. * Ability to propose and, with supervision, implement solutions to identified trends or problem areas with recommendations for improvement. * Excellent clinical, written and oral communication skills. * Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
Licensure, Certifications, and Clearances:
* New York licensure: LMSW, LCSW, LMHC, LMFT, licensed RN (with BSN) and/or a licensed PhD (psychologist) preferred. * Justice Center Clearances
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities
Salary Range: $27.43 to $46.22 / hour
Union Position: No
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.