Quality Management Specialist

Posted 2 Days Ago
Be an Early Applicant
Philadelphia, PA, USA
In-Office
Mid level
Behavioral Health
The Role
Supports quality management operations by tracking and trending quality issues, investigating clinical concerns, preparing reports, facilitating provider meetings, conducting provider visits, monitoring improvement plans, and coding significant incident reports. The role requires behavioral health or healthcare expertise, knowledge of Pennsylvania regulations and medical necessity criteria, strong communication and facilitation skills, and Philadelphia residency.
Summary Generated by Built In
 
CBH is a dynamic organization dedicated to providing access to high-quality, accountable care to improve the health and mental wellness of our members. As part of our growth, we are seeking a detail-oriented Quality Management Specialist to join our team.

CBH Job Level: 4


CBH offers a robust compensation and benefits package, including:

  • Family Planning, Fertility, Adoption Benefits
  • 403B Retirement Plan
  • PTO Days/Sick Days
  • Wellness Program
  • Employee Assistance Program
  • Health, Dental, Vision Insurance
  • Medical, Prescription Drug Insurance
  • Tuition Reimbursement
  • Commuter Benefits
  • Flexible Spending
Position Overview: 

The Quality Management Specialist is responsible for assisting in the daily operation of the Quality Management processes.   This entails tracking, trending and resolving significant incidents and quality concerns.

Essential Functions: 

  • Assists in the tracking and trending of all reported quality issues and produces trend analysis.
  • Investigates clinical quality issues and completes all required reports and related documentation.
  • Facilitates provider teaming meetings. Conducts on-site provider visits, monitors Quality Improvement Plan submissions, and prepares required letters to providers.
  • Assist with coding of all Significant Incident Reports and determining level of follow up warranted. 

Position Requirements: 

  • Education: Master’s degree in behavioral health, healthcare or social sciences
  • License/Certification:   N/A
  • Relevant Work Experience:   Minimum of 3 years of post-graduate experience with at least 2 years of experience in a health care or quality management setting

Skills:

  • Proficient in Microsoft Office applications
  • Excellent written and verbal communication skills
  • Must have knowledge of PA Act 68, Appendix H and medical necessity criteria
  • Customer service skills
  • Training and facilitating skills
  • Strong interpersonal skills
  • Thorough knowledge of DBH and DHS systems and services

Philadelphia Residency Requirement:

  • The successful candidate must be a current Philadelphia resident or become a resident within six months of hire. 

U.S. Authorization Requirement: 

  • CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:   

  • We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation: 

  • CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired. 
  • If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at [email protected] 

Skills Required

  • Master's degree in behavioral health, healthcare, or social sciences
  • At least 3 years of post-graduate work experience
  • At least 2 years of experience in a healthcare or quality management setting
  • Knowledge of Pennsylvania Act 68, Appendix H, and medical necessity criteria
  • Proficiency with Microsoft Office applications
  • Excellent written and verbal communication skills
  • Customer service skills
  • Training and facilitation skills
  • Strong interpersonal skills
  • Thorough knowledge of DBH and DHS systems and services
  • Current Philadelphia residency or willingness to establish residency within six months of hire
  • Legally authorized to work in the United States without current or future sponsorship
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The Company
HQ: Philadelphia, Pennsylvania
713 Employees
Year Founded: 1997

What We Do

CBH is a nonprofit 501 (c)(3) corporation contracted by the City of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services to manage the delivery of behavioral health services for Medicaid recipients of Philadelphia County. For more information about CBH, visit cbhphilly.org. For more than 25 years, Community Behavioral Health (CBH) has been expanding access to mental health services for Philadelphians. CBH provides access to high-quality, accountable care to improve the health and mental wellness of our Members. Our Mission: CBH provides access to high-quality accountable care to improve the health and mental wellness of our members. Our Vision: Leading innovation in whole-person care for healthy, thriving communities. Our Values: We Care. We value and appreciate our staff and service providers, believing that a healthy, happy workforce creates healthy, happy members. We show our appreciation regularly and listen to concerns. We also care deeply for the overall health of Philadelphians, knowing that a vibrant, thriving, resilient city hinges upon healthy citizens. We Empower. We are here for our employees, members, and partners. We are open and transparent, encouraging dialogue and fostering growth so we can all be our best, healthiest selves. We Connect. We’re updating our processes and technology to better serve our community and communicate more effectively and efficiently. We cultivate two-way communication, sharing our appreciation for our staff and welcoming feedback from them. We Lead. Behavioral and mental wellness is our passion, and we are experts in the field. We have been serving the Philadelphia community since 1997, and we know the industry. We cultivate close working relationships with our partners, who are also leaders in the mental health field. We are open to change and innovation to ensure the highest standard of care for all.

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