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  • Quality Improvement Administrator (Licensed Counselor or Psychologist)

A leading Healthcare provider in the Pacific Northwest is seeking a licensed counselor or psychologist to contribute to the company's quality and process improvement activities and initiatives. As a Quality Improvement Administrator for the Quality and Risk Adjustment team, you will collaborate with others and facilitate quality program goals and objectives to ensure the Company engages in ongoing improvement of member health and wellness.

You will provide subject matter expertise and leadership to ongoing operational activities supporting the company's quality efforts, as well as professional review of quality of care complaints and develop health, clinical, service and process improvement strategies in collaboration with many areas of the Company, Providers, and other healthcare entities.

Job Responsibilities:

Act as a knowledge expert for continuous quality improvement (QI) activities, educating staff of other functional areas regarding the process and accreditation requirements
Establish, maintain, and/or revise Quality Program documentation, as well as develop, implement and evaluate clinical and service quality improvement projects, including work plans, status reports, policies, procedures, committee presentations and all documentation required to meet regulatory and accrediting requirements.
Pursue methods to ensure receipt of relevant data, as required for accurate trending of various QI work plan metrics.
Perform quality of care complaint/adverse event review and assessment of medical record review results and recommend actions to address any identified improvement opportunities.
Work with QI Manager and Quality Medical Director to convene various QI committees and work groups, set agenda to drive desired meeting outcomes, and ensure proper recording of committee activities. Collaborate with Medical Directors and external MDs to ensure clinical appropriateness of quality improvement projects and facilitate alignment between the Company and contracted providers regarding evidence-based care protocols impacting quality and safety.
Analyze key plan metrics, such as HEDIS results, to enable the development of sound and valid recommendations regarding and prioritization of clinical and service improvement initiatives. Recommend methods to improve network provider compliance to health plan quality activities, including HEDIS rates and efforts to increase provider compliance to practice guidelines, such as newsletter articles, provider outreach and interventions, provider handbook content and provider feedback groups
Manage and monitor clinical quality studies to include receipt and analysis of trended data, assessment of national benchmarks as available, development of improvement recommendations presentation to senior leadership, implementation of plan, and evaluation for desired result. Recommend strategies to improve member compliance to QI program activities, addressing methods to change knowledge, attitudes and behaviors, such as web content, newsletter articles, member outreach interventions, and member focus groups
Facilitate fielding of various member and provider surveys that support accreditation, working with vendor to clarify results and present findings and recommendations to senior leadership. Assist with efforts to secure successful NCQA accreditation. Perform activities to comply with annual HEDIS data collection and analysis, as appropriate.

Job Requirements:

Bachelor's degree in Health Care Administration, Health Education, Nursing or related health field.
Current State Licensure as a behavioral health clinician where licensing is required by State law.
Five (5) years of clinical experience and two (2) years of experience in health plans.
Experience implementing programs/processes to meet regulatory and accreditation requirement is preferred

Competitive Benefits Package
PAY: 80K-95K Annually
DIRECT HIRE

For IMMEDIATE consideration please respond with resume to Savannah@provisional.com!
Quality Improvement Administrator (Licensed Counselor or Psychologist)
Direct-Hire
North Seattle
12787
Provisional
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Posted May 12, 2017

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