Description

Humana’s Louisiana Medicaid Behavioral Health (BH) Quality Management Coordinator will integrate quality throughout the organization by overseeing all areas related to BH quality performance measures and improvement projects. This role will support integrated physical and behavioral innovations and assist with the development of intervention of strategies that ensure individual and systematic quality of care. They will work closely with Humana’s Louisiana Medicaid Quality Director, Performance/Quality Improvement (P/QI) Coordinator and other staff as needed to improve specialized BH services.

Responsibilities

Humana’s Louisiana Medicaid Behavioral Health (BH) Quality Management Coordinator will integrate quality throughout the organization by overseeing all areas related to BH quality performance measures and improvement projects. This role will support integrated physical and behavioral innovations and assist with the development of intervention of strategies that ensure individual and systematic quality of care. They will work closely with Humana’s Louisiana Medicaid Quality Director, Performance/Quality Improvement (P/QI) Coordinator and other staff as needed to improve specialized BH services.

Essential Functions and Responsibilities

  • Support the Quality Director in operation on an NCQA compliant program.
  • Support development of the Annual Quality Program Description, Annual Quality Work Plan, and the Annual Quality Program Evaluation.
  • Select and implement BH national and region based quality metrics, policies, and procedures.
  • Utilize data to identify, develop and implement evidence-based quality improvement and process improvement strategies for BH.
  • Coordinate with interdisciplinary teams (i.e. physical health, population health, community engagement, etc.) to integrate quality improvement processes and BH evidence based practices.
  • Review, resolve, track, and trend quality of care complaints/grievances for BH.
  • Coordinate with relevant internal/external stakeholders, providers, the Louisiana Department of Health (LDH), and other entities to address quality of care issues associated with enrollee grievances for BH
  • Advise managers of relevant Humana departments on strategies to improve effective, appropriate, and culturally-competent delivery of services.
  • Author correspondence, proposals, reviews, audit analysis, and technical documentation related to quality management initiatives.
  • Present trends to regional based quality committees.
  • Ensure compliance with National Committee for Quality Assurance (NCQA) Accreditation by working with the Contract Compliance Officer and Regulatory Compliance Officer.

Required Qualifications

  • Licensed BH clinician or registered nurse (trained in BH), MD, DO or PA.
  • Certified Professional in Healthcare Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ) and/or certified in Healthcare Quality Management (CHCQM) by the American Board of Quality Assurance professional (LBHP).
  • LEAN for Healthcare or LEAN Six Sigma or other professional training in quality management.
  • Minimum three (3) years of experience in quality management and quality improvement as described in 42 CFR 438.200- 438.242 of the Federal Medicaid Managed Care Regulations.
  • Strong understanding of HEDIS/CMS/TJC and other national quality measures- particularly those focused on BH.
  • Demonstrated experience in healthcare quality improvement methods and improving BH metrics.
  • Demonstrated understanding of BH services, BH provider operational processes, and provider’s barriers and challenges to improved quality of care.

Preferred Qualifications

  • Master’s degree in Social Work, Nursing, Psychology, or related field.
  • Advanced knowledge of large and complex healthcare systems, health plans/managed care, quality tools, quality investigations, NCQA/URAC standards, Medicaid expansion, State Based Medicaid contracts and implementation.
  • Experience in driving provider level quality improvement initiatives and outcomes to achieve quality targets.
  • Strong understanding of quality improvement culture, behavioral change models.

Additional Information

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40


7 days ago - source