Behavioral Health Quality/Compliance Specialist

Overview

To prepare, analyze, report, and manage compliance of PHC’s Wellness & Recovery program,through both internal and external efforts. Works collaboratively with departments companywide to identify data needs, develop and maintain tools, and complete accurate reporting ofcompliance.

Responsibilities

• Tracks and reports trends in corrective action plans (CAP), both internal and external andmakes recommendations to place a CAP where requirements are not being met.
• Develops and maintains processes for tracking compliance of behavioral health systems,both internal and external, including CalOMS, DATAR, open admissions, open provider,and bed availability to ensure compliance by PHC and providers. Conducts accessibilityreviews to ensure timely access standards are being met.
• Ensures compliance of DMC-ODS and SABG requirements.
• Works collaboratively with various departments to ensure required provider trainings areoffered. Tracking of completion and/or attestations for inclusion in annual audits.
• Leads and/or participates in preparation and responses to annual audit, monitoring, andquality reviews, such as EQRO, DHCS annual audit, and quarterly ODS monitoring.
• Participates in annual PIP activities.
• Participates and/or facilitates Network Adequacy efforts annually.
• Develops and executes data collection plans to support adequate reporting of compliance,including transitions of care and timely access.
• Makes recommendations for inclusion of regulatory requirements in annual QualityImprovement Programs (QIP).
• Serves as a primary contact for internal and external stakeholders related to PHCcompliance with SABG and DMC-ODS requirements.
• Serves as lead on select operational initiatives as assigned.
• Maintains expert knowledge of assigned business unit.

Qualifications

Education and Experience

Bachelor’s degree in Business Administration, Business Management,Computer Science or relevant field preferred. In lieu of degree, aminimum of three (3) years of relevant experience will be considered.

Special Skills, Licenses and Certifications

Demonstrated aptitude for acquiring and applying technical skills indata analysis, reporting, and data systems. Good oral and writtencommunication skills. Strong analytical skills including knowledge ofstatistics. Excellent interpersonal skills. Valid California driver’slicense and proof of current automobile insurance compliant with PHCpolicy are required to operate a vehicle and travel for companybusiness.

Performance Based Competencies

Knowledge of MS Excel, Access, and other analytic software.Knowledge of Lean and Model for Improvement methodologies.Familiar with quality measurement and healthcare data. Ability tocommunicate technical concepts with both technical and non-technicalindividuals. Detail-oriented with good organizational and projectmanagement skills to work on multiple projects simultaneously withinestablished time frames

Work Environment And Physical Demands

Ability to use a PC with standard software packages. More than 70% ofwork time is spent in front of a computer monitor. When required,ability to move, carry, or list objects of varying size, weighing up to 25lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated. 

HIRING RANGE:

$85,173.51 - $106,466.89

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Salary : $85,174 - $106,467