Quality Improvement Coordinator (Behavioral Health)
Location: Baton Rouge, Louisiana
Description: LA Healthcare Connections is currently seeking to employ Quality Improvement Coordinator (Behavioral Health) right now, this job will be reside in Louisiana. More complete informations about this job opportunity please give attention to these descriptions.
Position Responsibilities:
Develop and implement the quality program description, work plan goals including applicable Healthcare Effectiveness Data and Inf ormation Set (HEDIS) measures and program evaluation (trilogy documents) for behavioral health
Lead Behavioral Health Performance Improvement Projects (PIPS)
Review clinical information for appeals to determine medical necessity
Prepare cases for appeals that do not meet medical necessity
Maintain files, logs, documentation including communication in accordance with National Committee for Quality Assurance (NCQA) and State standards and regulations including timelines
Investigate and resolve behavioral health quality of care complaints and grievances
Develop and implement the quality program description, work plan goals including applicable Healthcare Effectiveness Data and Inf ormation Set (HEDIS) measures and program evaluation (trilogy documents) for behavioral health
Lead Behavioral Health Performance Improvement Projects (PIPS)
Review clinical information for appeals to determine medical necessity
Prepare cases for appeals that do not meet medical necessity
Maintain files, logs, documentation including communication in accordance with National Committee for Quality Assurance (NCQA) and State standards and regulations including timelines
Investigate and resolve behavioral health quality of care complaints and grievances
Qualifications:
Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, prepare reviews for cases, act as the liaison for appeals and fair hearings.
Education/Experience: Associate’s degr ee in Nursing or other related field of study. 2+ years’ experience in Clinical Nursing and 1+ year of experience in Quality, Managed Care or Healthcare Administration required. Experience in Behavioral Healthcare field preferred.
Licenses/Certifications: Registered Nurse (RN) certification or a Licensed Mental Health Professional (LHMC) required.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, prepare reviews for cases, act as the liaison for appeals and fair hearings.
Education/Experience: Associate’s degr ee in Nursing or other related field of study. 2+ years’ experience in Clinical Nursing and 1+ year of experience in Quality, Managed Care or Healthcare Administration required. Experience in Behavioral Healthcare field preferred.
Licenses/Certifications: Registered Nurse (RN) certification or a Licensed Mental Health Professional (LHMC) required.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to LA Healthcare Connections.
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This job will be opened on: Sat, 05 May 2018 01:52:21 GMT
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