Manages the day-to-day Quality Management functions for Behavioral Health. Identifies opportunities for performance improvement initiatives and coordinates activities to ensure efficiency and effectiveness. Provides oversight of Quality Improvement projects and coordinates and collaborates with management and clinical staff on development and implementation of projects and on achievement of goals. Assists with the development of methods and criteria for assessing, measuring, and evaluating quality of care, care management services, regulatory compliance, and performance for government and managed care funders. Ensures compliance with regulatory requirements for all products and programs. Works under general direction.
Responsibilities
Manages day-to-day quality management functions and provides direction to staff to ensure program needs are met. Monitors and ensures contractual and regulatory requirements are met; works with program management to design corrective actions as needed; ensures corrective action plans are submitted on time and monitors adherence to these plans; coaches and supports staff in the implementation of corrective action plans. Ensures solutions are consistent with program objectives, organization’s policies and regulatory requirements. Collaborates and coordinates with staff on day-to-day issues that compromise adherence to quality and performance standards.Identifies quality, utilization, and other indicators according to program goals. Collaborates with Behavioral Health (BH) management to collect and report data evaluating program performance. Reports metrics to management.Manages the development, implementation, and evaluation of policies and procedures for Behavioral Health (BH) programs to ensure appropriate regulatory and professional standards are met and updated as needed.Oversees the maintenance of policy and procedure manuals, including placement and archiving on the intranet, and communication to staff.Participates in department strategic planning to develop objectives that are in alignment with department and program quality objectives. Develops methods for evaluating performance and monitoring of department objectives and reports results to BH leadership.Develops and maintains knowledge of current or new regulatory requirements governing government and managed care contract compliance.Works with other departments to ensure dashboards, reporting, and systems are in place to support quality programs and initiatives including value-based relationships and internal program monitoring.Identifies opportunities to improve quality measure performance. Develops and manages implementation plan. Develops control mechanisms and monitors efficiency of quality improvement initiatives.Manages BH Incident Tracking and Review Process. Ensures incidents are reported and closed out within required timeframes; monitors internal VNSNY incident tracking system and OMH incident tracking system. Schedules, leads and documents quarterly incident review meetings.Ensures timely and accurate billing, working with Revenue Cycle Department and BH program managers and staff.Monitors and oversees data entry timeliness and data quality in the various EMR’s used by BH.Serves as back-up System Administrator for city and state databases, creating new User ID’s and deactivating User ID’s when staff are separated or transfer out of BH programs.Assists with analysis of surveys and audits including but not limited to NY City and State agencies and contracted insurance plans. Collaborates with BH management and staff to develop initiatives and action plans to improve audit results and billing accuracy.Participates in the development and implementation of quality projects and initiatives across all BH programs.Participates in special projects and performs other duties as required.
Qualifications
Education: Bachelor’s degree in Science, Health Care, or a related field or the equivalent work experience required. Master’s Degree in Health Care or related field preferred.
Experience: Minimum of four years of experience in clinical quality improvement and measurement required. Minimum of three years of project management experience required. Proficient in knowledge of health care delivery systems and patient care required. Knowledge of NYS OMH and NYC DOHMH quality regulations required. Effective oral/written communication, presentation skills required. Proficiency with Microsoft Office suite required.