Mgr BH Clinical Quality
Employment Type: Full-Time
SHIFT: Day Job
Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it's a powerful combination. It's the foundation upon which we're creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
Responsible for managing the day-to-day activities of one or more behavioral health (BH) clinical quality program components, Performance Measurement and Quality Improvement, NCQA accreditation and/or other quality assurance related activities for one or more health plans. The manager is a client facing role, attending joint operating and other committees as required by the health plan(s).
Primary duties may include, but are not limited to:
* Implements and evaluates current behavioral health processes including operational statistics, service standards and process improvement initiatives.
* Provides oversight in the planning, implementation and coordination of BH health care audits to ensure high quality, cost effective care.
* Participates in internal and external BH quality review activities.
* Responsible for daily clinical/quality operations including: complaint/grievance system, quality of care reviews, adverse incidents, potential of quality of care issues, and a subpoena request, facilitating and managing quality committees, quality trilogy documents, quality training for staff and other departmental staff, responsible for maintaining and updating quality policies and procedures and SOP's and serves as lead for cultural and linguistic programs
* Manages and oversees BH quality assurance activities, which may include, but is not limited to: managing the production, analysis, overseeing community health promotion and disease management initiatives in each state in the region; coordinating audit activities with other regions; managing achievement and maintenance of NCQA accreditation; scheduling all information for surveys, conducting mock audits, and providing consultation to business units and team leads as regards NCQA standard issues.
* Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires BA/BS degree and a minimum of 3 years of managed care experience including experience in program development and knowledge of the quality process and QI techniques, or any combination of education and experience which would provide an equivalent background.
MS degree preferred.
Minimum of 2 years leadership experience
Experience with NCQA/URAC
Experience with CA Department of Managed Care Health
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World's Most Admired Companies among health insurers by Fortune magazine, and a 2020 America's Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.