Quality Management Specialist II in Rocky Hill, CT at Beacon Health Options

Date Posted: 11/25/2019

Job Snapshot

Job Description

About the Position:

Reviews provider treatment records as part of the CT BHP Record Review Program for the purpose of ensuring quality of care, verifying documentation to support information received during medical necessity reviews, and confirming conformance with treatment record documentation standards. 

Participates in the Quality of Care Committee and plays an active part in coordinating the tasks involved in keeping that committee functioning at a high level. Participates in audits of Beacon clinical staff documentation for thoroughness. 

Position Responsibilities:

1.      Assists in the identification and notification of providers who will participate in the treatment record review process.  Arranges all necessary details to begin on site review and communicates with providers as necessary.

2.    Conducts record reviews in a timely and accurate manner and summarizes salient preliminary findings with the provider at conclusion of review. 

3.      Prepares final reports to providers by summarizing findings and identifying required actions in consultation with review team.

4.      Communicates with provider following review to ensure that required reports are received in a timely fashion.  Reviews recommendations of final report with provider.

5.      Maintains accurate reporting of record review status, e.g., scheduled review date, completion dates, dates of reports completed, number of records reviewed, provider response due date, and date of next review.

6.      Participates in periodic inter-rater reliability testing for record review accuracy and achieves a passing grade.

7.      Provides technical assistance to providers regarding medical record maintenance.

8.      Works effectively with all Beacon departments to ensure provider compliance with plans of correction.

9.      Plays a lead role in maintaining the Quality of Care Committee including maintenance of files associated with the committee and meeting minutes. 

10.  Review provider records submitted to Beacon based on potential quality of care concern.  Elevate for medical director review as appropriate.

11.  Maintains a working knowledge of Beacon documentation standards and requirements.

12.  Conduct internal documentation audits of Beacon clinical staff documentation. 

Position Requirements:

Education: Master's level clinician 

Licensures: Licensed for appropriate disciple

Relevant Work Experience: 5 years of professional experience in the mental health /substance abuse field.  General knowledge of managed care, quality management, and utilization management principles preferred.  Good writing, analytical, and verbal presentation skills.

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

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.