Current Job Openings for Healthcare Professionals

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Performance Improvement Specialist


Performance Improvement Specialist
 
Responsible for oversight and plan development of quality improvement initiatives, internal and external education, coordination of improvement projects, conducting data collection, reporting and monitoring of key performance measurement indicators, and providing subject matter expertise regarding quality improvement approaches.  Occasionally this position may be asked to travel to another community office location to maintain coverage.
Essential Functions
Primary Responsibilities:
  • Implementing identified quality strategies, which may include initiation and management of provider, member and/or community interventions (e.g., identifying and removing barriers to care); preparation for quality oversight surveys; and other federal and state required quality activities.
  • Monitoring performance and quality activities for timely completion and accuracy.
  • Preparing and presenting executive and detail level summary of quality activities as needed. 
  • Writing narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings of department interventions.
  • Creating, managing and/or compiling the required documentation to maintain critical quality improvement functions.
  • Leading quality improvement activities, meetings and discussions with and between other departments within the organization.
  • Evaluating project/program activities and results to identify gaps and opportunities for improvement.
  • Attending meetings/trainings as needed to stay informed of changes in clinical best practices, local, State, Federal and Division requirements.
  • Other tasks, duties, projects and programs as assigned.
Qualifications
Knowledge, Skills, & Abilities:
  • Experience working with quality improvement approaches and strategies
  • High level of diplomacy and discretion is required to effectively negotiate and resolve issues
  • Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
  • Excellent written and oral communication skills.
  • Demonstrate strong business writing skills.
  • Retain large amounts of information and be able to interpret written rules/regulations.
  • Possess organization skills that allow them to balance a wide variety of task in a time-effective manner. 
  • Demonstrate proficiency in Visio or flow chart equivalent and Microsoft Office products and be able to quickly learn new software tools.
Education and Work Experience
Education and Experience:
  • Bachelor’s Degree in Social Services, Public Health, or Healthcare Administration or in a related field. May substitute for equivalent experience.
  • 3 years of healthcare or behavioral healthcare experience with 1-year experience in health-related quality improvement, or equivalent experience.
  • 1 year of experience in Medicare and/or Medicaid preferred.
  • Formal training in quality improvement techniques preferred.
Valid Driver’s License Required: Yes Travel Type: Domestic Percentage:   0 - 5
Language: Read Write Speak
English
Spanish
Other:
Licensure and/or Certification
Preferred but not required:
  • Certified Professional in Health Quality (CPHQ)
  • Nursing License (RN)
  • Lean Six Sigma certification
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HEDIS Specialist


HEDIS Specialist
Responsible for oversight and plan development for HEDIS-related initiatives, internal and external education, maintenance of programs for members in accordance with HEDIS-related measures, conducting data collection, reporting and monitoring of HEDIS quality measures, and coordination of compliant HEDIS submissions.  Occasionally this position may be asked to travel to another community office location to maintain coverage.
Essential Functions
Primary Responsibilities:
  • Implementing identified HEDIS-related improvement strategies, which may include initiation and management of provider, member and/or community interventions (e.g., identifying and removing barriers to care)
  • Coordination and preparation for HEDIS validation, auditing, and submission.
  • Monitoring performance and HEDIS quality activities for timely completion and accuracy.
  • Preparing and presenting executive and detail level summary of HEDIS-related activities as needed. 
  • Working with internal departments to address gaps in care, coordinate efforts with providers, and document findings of department interventions.
  • Creating, managing and/or compiling the required documentation to coordinate HEDIS-related functions.
  • Leading HEDIS-related improvement activities, meetings and discussions with and between other departments within the organization.
  • Attending meetings/trainings as needed to stay informed of changes in HEDIS measurement requirements and best practices.
  • Other tasks, duties, projects and programs as assigned.
Qualifications
Knowledge, Skills, & Abilities:
  • Experience working with HEDIS software vendors (management, building relationships, issue resolution, etc.).
  • High level of diplomacy and discretion is required to effectively negotiate and resolve issues
  • Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
  • Excellent written and oral communication skills.
  • Demonstrate strong business writing skills.
  • Retain large amounts of information and be able to interpret written rules/regulations.
  • Possess organization skills that allow them to balance a wide variety of task in a time-effective manner. 
  • Demonstrate proficiency in Visio or flow chart equivalent and Microsoft Office products and be able to quickly learn new software tools.
Education and Work Experience
Education and Experience:
  • Bachelor’s Degree in Social Services, Public Health, or Healthcare Administration or in a related field. May substitute for equivalent experience.
  • 2 years of experience managing HEDIS outcomes with a health plan, behavioral health plan, or HEDIS-related vendor
  • 1 year of experience in Medicare and/or Medicaid preferred.
  • Project Management experienced preferred.
Valid Driver’s License Required: Yes Travel Type: Domestic Percentage:   0 - 5
Language: Read Write Speak
English
Spanish
Other:
Licensure and/or Certification
Preferred but not required:
  • Certified Professional in Health Quality (CPHQ)
  • Nursing License (RN)
  • Certified HEDIS Compliance Auditor (CHCA)
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Access Clinical Supervisor


Access Clinical Supervisor 

This Supervisor provides day to day oversight of call center operations (24/7/365), including monitoring performance metrics. The Supervisor ensures appropriate coverage for all shifts, call lines, schedule adjustments, and call routing to manage volume between lines to fully support the fast-paced call center. The Supervisor ensures high-quality customer service is provided to callers, through developed processes, protocols, and call scripts. The employee will act as one of the Supervisors for call center operations, including the Access Crisis Line, and the provider and member service lines. Other supervisory responsibilities include the completion of all required Human Resources documentation as per procedures. This position will also provide direct services covering calls as needed to support overall operations and act as the back-up contact for members requesting behavioral health services.

Essential Functions:

The Access Clinical Supervisor is responsible for (though not limited to)

· Assisting in the creation and maintenance of daily schedules to provide consistent staffing for the workload of the Access team. This includes maintaining adequate FTEs to handle all work volume.

· Act as the primary point of contact for support to line staff when facing an issue related to call handling and/or general referral practices.

· Monitors assigned staff performance, inclusive of monitoring against expected metrics and development of action plans when necessary

· Monitoring interactive technology and report any problems to the appropriate leadership staff within the department as well as other business units such as Infrastructure Technology (IT) Department

· Completing and ensuring that staff complete all required documentation based on established requirements, inclusive of ensuring the incorrect information is updated for appropriate tracking

· Providing initial and ongoing orientation, training and supervision for staff.

· Complete training and other reimbursement requests submitted by staff.

· Complete calendar time off requests and training requests for staff, making sure to update the shared schedule spreadsheet, ensuring that any operating procedure related to coverage are followed.

· Complete and provide supervision summary to staff monthly drawing upon audit results and call statistics.

· Develop and implement Corrective Action Plans (CAPs) as needed

· Conduct monthly and or quarterly blind call audits and documentation audits on staff at designated intervals

· Monitor and support developing performance goals and providing coaching/support/intervention as needed to promote success. Provide supervision summary to staff for the month’s prior outcomes or before and complete appropriate documentation of the supervision

· Provide daily phone consultation support and via instant messaging applications for support as needed by staff for call handling.

· Review all adverse event notifications provided by staff and provide review in the corresponding notes. Provide validation/verification of all adverse event calls. Provide weekly verification of adverse event, other and non-threshold call notes. Appropriate labeling of corresponding call notes and follow up on any corrections needed with staff and/or the log entries. · Act as the Subject Matter Experts (SMEs) on all referral and call handling procedure activities – other, non-threshold, routine, urgent, emergent, transfer processes, etc. · May be responsible for overseeing specialty projects, participation in committees, etc. to support the overall organization · Other tasks, duties, or assignments per directive of Access Leadership. · This is a highly independent position. This position requires adaptability of the staff to meet and prioritize the needs within the busy call center setting. Staff report directly to the Access Coordinator Manager. Regular supervision will be scheduled. Attendance to Monthly Staff meetings and other mandatory meetings and trainings are required.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· Knowledge of Call Center practices and operations, inclusive of call routing, call tiering, and managing multiple lines simultaneously.

· Knowledge of quality improvement indicators and procedures.

· Comprehensive knowledge and experience in working with various computer programs including Microsoft Word, Excel, and Cardinal Innovations. Ability to navigate multiple computer systems.

· Ability to work evenings and weekends

· Knowledge of clinical protocols to ensure referrals to appropriate level of care.

· Knowledge of community resources outside of mental health; substance abuse and developmental disability to provide diversions to alternative care when applicable.

· Therapeutic and crisis intervention experience; Knowledge of available resources within the served catchment areas.

· Strong clinical knowledge of diagnosis, best practices, and various screening tools

· Ability to provide Administrative On Call coverage in rotation with other members of the Access Leadership team.

· Strong customer service skills required

 

Education and Work Experience:

Education and Experience: Master’s Degree in Social Work or related field with at least 2 years post-licensure experience in a Mental Health, Intellectual Disability / Developmental Disability and/or Substance Abuse setting. Requires a current
North Carolina Clinical License. Prior call center experience preferred

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Lead Implementation Coordinator


Lead Implementation Coordinator

The Lead Implementation Coordinator coordinates with the team related to service implementation and behavioral health initiatives. The Coordinator develops content through collaboration with other business units such as communications and training, for internal and external stakeholder’s presentations ensuring that all stakeholders have a foundational understanding of the information. The coordinator ensures program details are clear and understandable for the intended audience and may facilitate educational sessions prior to implementation. The Coordinator will update information based on feedback or modifications. The role is responsible for ensuring information on the behavioral health services and programs is up to date and easily accessible for a wide range of audiences. The Coordinator may assist in the development of job aides, question and answer (Q&A) content, or other needed materials to ensure consistent information is provided.

Essential Functions

Primary Responsibilities:

· Works as part of a cross-functional team on service implementation to ensure information is shared internally and externally for successful implementation

· Ability to gather information from subject matter experts and develop standardized educational materials

· Ability to adapt content based on the intended audience or when changes occur

· Develop a standard framework for updating information, reviewing, and routinely sharing information to ensure full awareness of the available support for the designated populations

· Provide input to the development of implementation plans with the goal to ensure these are achievable and value-added

· Monitor the measure of success and identifies opportunities for process improvement

· Provide guidance and recommendations to ensure seamless implementation, including identification where collaboration on multiple initiatives rather than siloed work can be beneficial to optimize stakeholder experience and outcomes

· Collaborate with business units to understand strategic goals and promote an environment conducive to creativity, changes, and information exchange

· Assist in developing new training curricula for service implementation or program initiatives

Qualifications

Knowledge, Skills, and Abilities:

· Ability to gather business requirements, create, execute and utilize a variety of tools to improve the overall operational efficiency implementations

· Ability to work effectively and meet deadlines in a rapidly changing environment, while handling multiple projects at a time whether individually or working with a team

· Exceptional interpersonal, organizational, leadership, and decision-making skills.

· Career-oriented with a positive, energetic attitude, strong analytical, organizational, and communication skills.

· Ability to work independently but keep cross-departmental teams updates, and provided with the needed information for status reports to stakeholders · Ability to develop clinical content and member-centered content to explain services and programs · Excellent organizational skills and demonstrated ability to meet project deliverables. · Ability to instill confidence, influence others, and represent the organization at meetings, conferences and events · Strong communication skills including written communications, as well as ability to present information to various stakeholder groups.

Education and Experience:

· Bachelor’s degree required. Advanced degree preferred

· Four 4+ years’ experience with program implementation in a healthcare setting.

· Experience using analytical and problem-solving skills; interpreting and summarizing complex data as it relates to program and/or service implementation

· Experience presenting reports, presentations, and recommendations to the team and senior management in a clear, concise, and actionable manner

· Familiarity with managed care operations preferred

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Medical Services Nurse


Medical Services Nurse

The Medical Service Nurse will provide organizational support to processes related to denial, appeals, and consultation for

complex cases. This position serves as a point of contact for all functions related to these activities, helping to triage any areas

that need clinical escalation. This position works closely with the overall Medical Department and Clinical Operations team. The

position will collect detailed data on processes to help identify training needs, ensure compliance with timelines and other

regulations, as well as opportunities for increased efficiency or process improvement. Additional duties include serving as an

educator within the organization and the community. Reports directly to the Director of Medical Services Operations.

Essential Functions

Responsibilities and Duties:

· Collaborate with other departments to best support the denial and appeal process

· Utilize clinical knowledge of a range of diagnoses and/or co-occurring conditions to offer suggestions on treatment

recommendations, options for clinical decisions, and identification of when broader consultation is needed.

· Utilizes knowledge, clinical skills and techniques such as clinical best practice for treatment of mental health/substance

use disorders as well as physical health of members

· Collaboration with the Director Medical Services, Operations to provide and ensure that peer advisor staff provide

member support and information when questions arise about the denial and appeal processes

· Document accurately and comprehensively all contacts and other documentation as established.

· Assist with data collection of activities of both internal as well as external peer advisors to include tracking of peer advisor

consultations, denials, appeals and rounds. This may include clinical review of externally contracted peer advisors.

· Perform community education and outreach as well as support to other staff or providers.

· Partner with other departments to improve efficiency, clinical quality, and procedures related clinical management.

· Provide nurse case summaries when necessary to prepare for consults or a multi-disciplinary staffing.

· Ensure all processes are completed with compliance to contracts, accreditation, services requirements, etc. (from state

contract)

· Assist Director of Medical Services Operations with implementation of Peer Advisor Productivity as well as Inter-rater

reliability measurements within the Medical Department

· Participate in multidisciplinary case conferences to provide direction and nursing recommendations to front line staff

managing complex and high-risk cases (possibly establishing open office hours)

· Provide clinical administrative support as well as clinical expertise to meet member and staff needs

· Identify medical and/or behavioral barriers to situation/complaint resolution and follows-up with the appropriate

resources or leadership to address timely and effectively

· Function as a resource for the IP care management team to assist with understanding of complex underlying medical

conditions.

· Facilitate the integration of physical and behavioral healthcare including detection of service needs, linkage to primary

care and collaboration with community agencies as needed to facilitate social determinant of factors of health

· Provide behavioral-specialized clinical knowledge to the physical health setting to support the primary care and other

providers

Qualifications

Knowledge, Skills and Abilities

· Strong organizational skills, with the ability to compile and track data for reporting and analysis

· Knowledge of documentation and clinical protocols for utilization purposes and case reviews including rounds for individual

members.

· Knowledge of providing linkage, authorizations and level of care determinations

· Knowledge of managed behavioral care practices and principles

· Knowledge of relationship development and collaboration with other services, providers, and other agencies that also

affect access and services within the system.

· Computer proficiency in e-mail, Microsoft suite applications (such as Teams, Word, Excel, Outlook, Power Point, etc.), and

the internet

· Knowledge of databases, care management system

Education and Work Experience

Education and Experience:

· RN or LPN with 5 years of combined Mental Health/ Substance Use Disorder populations and physical health populations

· Experience of hospital and outpatient settings including LTSS, preferred

· Experience working with the behavioral health population, and familiarity with managed care activities

· Experience managing projects, including development of goals, establishing timelines, and evaluation after

implementation

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