Quality Performance Specialist Behavioral Health Clinical

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

As part of the Quality Management team, the Behavioral Health Quality Performance Specialist -Clinical is responsible for the coordination and oversight of the behavioral health quality metrics, quality improvement activities and performance improvement projects. ;This role will collaborate with internal and external customers relative to behavioral health initiatives to complete impactful and time sensitive projects. The position also supports accreditation.

Principal Accountabilities:

• Prepares meeting packets, schedules meetings, develops agendas, completes minutes, and chairs the Behavioral Health Quarterly Workgroup.
• Develops reports and analysis for quarterly trending reports and presents to applicable Committees for input and direction.; Follows up on any recommendations.
• Maintains QM policies including annual reviews, updates, and approvals.
• Assumes the responsibility for reviewing sentinel events and member concerns reported for potential quality of care issues related to behavioral health. Coordinates reviews with physician advisors and clinical quality committees as appropriate.
• Conducts provider and member outreach and education relative to behavioral health initiatives.
• Supports the quality improvement department with annual medical record review activities including HEDIS, and Clinical Practice Guidelines by working collaboratively with the Quality Improvement Department.; Assistance will be based upon the organizations needs annually but may include participation in the development of medical record review tools, conducting training and testing of medical record review staff, and auditing medical record reviews upon completion.;;
• Performs other related duties and special projects as assigned.
• Travels to office, provider visits and community events as needed.
  
  

Education/ Experience:

• Registered Nurse with Clear/Active license in the state of Louisiana required.; Must have behavioral health experience.
• BSN or equivalent education & experience required for an RN. ;OR
• Social Worker (MS) and any of the following certifications:
• Licensed Mental Health Profession (LMHP),
• Licensed Clinical Social Worker (LCSW),
• Licensed Professional Counselor (LPC),
• Licensed Addiction Counselor (LAC).
• Minimum of 3 years in clinical or service quality improvement required.
• Minimum of 3 years in healthcare delivery required.;
• Managed Care experience preferred.
  
  

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

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