Quality Management Specialist Team Lead

4 days ago


Philadelphia, Pennsylvania, United States Community Behavioral Health Full time
Job Title: Quality Management Specialist Team Lead

Community Behavioral Health (CBH) is seeking a highly skilled Quality Management Specialist Team Lead to join our team. As a key member of our quality management team, you will be responsible for assisting in the daily operation of our Provider Monitoring processes.

Key Responsibilities:
  • Track and trend all reported quality issues and produce trend analysis.
  • Investigate clinical quality issues and complete all required reports and related documentation.
  • Conduct on-site provider visits, monitor Quality Improvement Plan submissions, and prepare required letters to providers.
  • Assist with coding of all Significant Incident Reports and determining level of follow-up warranted.
  • Assist with coding of all Quality Concerns.
  • Complete Credentialing Committee Report.
  • Complete weekly Bed Refusal report.
  • Complete weekly OMHSAS Mortality Report.
  • Complete bi-weekly Naloxone report.
  • Provide coverage for provider meetings and site visits.
  • Complete monthly provider licensure review.
  • Complete provider profiles as requested.
  • Provide support to new Quality Management Specialist during onboarding process.
Requirements:
  • Master's degree in behavioral health, healthcare, or social sciences.
  • Minimum of 3 years of post-graduate experience with at least 2 years of experience in a healthcare or quality management setting.
  • Proficient in Microsoft Office applications.
  • Excellent written and verbal communication skills.
  • Knowledge of PA Act 68, Appendix H, and medical necessity criteria.
  • Customer service skills.
  • Training and facilitating skills.
  • Strong interpersonal skills.
  • Thorough knowledge of DBH and DHS systems and services.
Philadelphia Residency Requirement:
  • The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.
U.S. Authorization Requirement:
  • CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.
Equal Employment Opportunity:
  • CBH is an equal opportunity employer and does not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals.


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