Quality Improvement Specialist Behavioral Health

The Quality Improvement Specialist Behavioral Health (BH) leads and supports the collection, analysis and reporting of data and the development of intervention strategies in support of BH quality improvement efforts. This position leads and supports quality improvement activities and multi-department workgroups across all lines of business, including the Medicaid, Commercial and Medicare-Medicaid product lines. The Specialist supports improvement efforts targeting quality and operational measures relating to contractual requirements and pay-for-performance programs and identifies and communicates areas where the organization is at risk of failing to meet contractual or pay-for-performance goals.

Duties and Responsibilities

Responsibilities include, but are not limited to the following: 

• Maintain an in-depth knowledge of behavioral health (BH) quality improvement requirements for all product lines
• Lead the preparation and submission of reports on regulatory-required quality improvement projects
• Lead and supports BH quality improvement projects for all product lines, inclusive of data collection, analysis, reporting, and improvement teams
• Lead and support identification and implementation of BH quality improvement activities across the organization, targeting priority measures and maintaining focus on health equity in all improvement activities
• Monitor and collaborate with internal and external partners to identify improvement strategies for quality measures  
• Participate in statewide workgroups relative to BH quality and collaborate with regulators on BH quality improvement initiatives
• Collect, organize, and present BH quality measure data to key external partners, including community health centers, CCBHCs, high-volume behavioral health providers, and others as needed
• Identify and communicate risk areas and barriers that could inhibit the organization’s ability to achieve the highest pay-for-performance incentives for all product lines
• Develop written reports inclusive of qualitative and quantitative analysis outlining conclusions and recommendations for improvement
• Participate in developing core quality improvement documents for the organization

• Develop and apply expertise in using internal and external data sources and benchmarks to meet the analytic challenges posed by quality improvement cycles
• Other duties as assigned
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

Qualifications

Required:

• Bachelor’s degree in Business or health-related field or relevant work experience in quality improvement to equate to a degree
• Three (3) + years’ experience working in healthcare, with substantial knowledge of the behavioral health system and provider environment
• Experience working with quality improvement methods and strategies, health care analytics, regulatory requirements and project management
• Experience working with statistical analysis of complex health care data sets, including health care claims, health surveys and health outcomes data, to support improvement activities
• Strong analytical, attention to detail, and critical thinking skills
• Demonstrated ability to develop and implement detailed project plans, including handling multiple projects simultaneously in a deadline driven environment
• Demonstrated ability to develop written reports inclusive of qualitative and quantitative analysis outlining conclusions and recommendations for improvement
• Excellent interpersonal skills, including the ability to work across the organization and externally and to interact, influence and negotiate effectively at all levels of management
• Confident team builder with strong motivational and problem-solving skills
• Effective communication skills, both verbal and written
• Outstanding time management and organizational skills
• Highly proficient in Microsoft Excel, PowerPoint and Word

Preferred:

• Three (3)+ years’ experience working in a managed care environment with focus on quality improvement, health care analytics and quality improvement requirements
• Experience in demonstrating leadership, influence and collaboration in a matrix-managed environment
• Two (2)+ years’ experience in the analysis and interpretation of health care data, such as health care claims data, public health surveillance data, health survey data and clinical data abstracted from medical records
• Knowledge of medical coding systems used for diagnoses, procedures, pharmaceuticals and clinical laboratory data

    Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.