Quality Management Specialist Team Leader

Position Overview: 

The Team Leader is responsible for assisting in the daily operation of the Provider Monitoring processes.   This entails tracking, trending and resolving significant incidents and quality concerns.

Core Expectations: 

Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission, vision, and corporate code of conduct. 

• Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
• Serve as a role model by exemplifying professional behavior, language, skills, and attire in order to promptly and accurately serve the needs of stakeholders, members and their families.
• Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost effective manner.
• Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality, dignity and rights.
• Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
• Actively participate in required meetings and complete all mandatory trainings.
• Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.
• Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste or abuse.

Essential Functions: 

• Assists in the tracking and trending of all reported quality issues and produces trend analysis.
• Investigates clinical quality issues and completes all required reports and related documentation.
• Conducts on-site provider visits, monitors Quality Improvement Plan submissions, and prepares 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 
• Completion of Credentialing Committee Report
• Completion of weekly Bed Refusal report
• Completion of weekly OMHSAS Mortality Report 
• Completion of 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 

Position Requirements: 

• Education: Master’s degree in behavioral health, healthcare or social sciences
• License/Certification:   N/A
• Relevant Work Experience:   Minimum of 3 years of post-graduate experience with at least 2 years of experience in a health care or quality management setting
• Skills:
• Proficient in Microsoft Office applications
• Excellent written and verbal communication skills
• Must have 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:   

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation: 

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired. 
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov