Clinical Quality Assurance Advisor at Beacon Health Options in Cypress, CA

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Beacon Health Options

Job Category: Clinical - Quality
Req #: CLINI02866
Schedule: Full Time
Location: CA - Cypress


We Help People Live their Lives to the Fullest Potential!

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

Do you have a passion for helping others? If so, we are looking for you!

Beacon is currently seeking a Clinical Quality Assurance Advisor to join our team based in Cypress, CA . The Clinical Quality Assurance Advisor partners with Management Team to evaluate CCM clinical and quality performance by monitoring calls and correspondence, daily. This individual will ensure the delivery of excellent service to internal and external customers across multiple clients and products. Through exceptional interpersonal and communication skills, effective leadership, planning, process management and information analysis, this individual will continually promote a customer focused environment. This position enhances customer loyalty by ensuring that managers and supervisors are continually apprised of critical service quality issues, staff receives appropriate training and performance feedback and management receives appropriate recommendations regarding staff development, etc...

What does a typical day look like?
  • Monitors, evaluates and documents member or provider calls for designated staff to ensure staff responses meet Beacon Health Options clinical and quality audit standards, and provides managers, supervisors and clinical care managers with call coaching quality data. Partners with the management team to ensure frequent performance and developmental feedback are provided to the HPS and VCC Clinical Referral Line staff.
  • Compiles/reports monitoring evaluation data and presents call coaching sessions. Provides CCM's with an action plan for process improvement, and if needed collaborates with the management team in the corrective action process by gathering documentation regarding noncompliance in meeting required standards. Contributes to performance improvement plans and participates in discussions, up to and including termination
  • Ensure processes are in place to support compliance with all state and federal laws (HIPAA), regulatory requirements, accrediting agencies (NCQA and URAC) as well as Beacon Health Options clinical criteria and policies and procedures.
  • Compiles and presents summary level call coaching and efficiency data which becomes part of each CCM's performance review. Assures integrity and confidentiality of call monitoring documentation and evaluates/develops monitoring tools to support efficiency and effectiveness in the call monitoring process.
  • Audits the timeliness and accuracy of any contractual follow up inquiries made by HPS, VASC, and VCC Clinical Referral Line staff. Measures the ability of CCM's to successfully meet all client performance expectations and presents final assessments/employment recommendations to management.
  • Identifies improvements or training opportunities and develops/presents quality improvement training materials to improve overall service quality. Identifies trends in inquiry monitoring and applies corrective actions as necessary to meet business needs. Ensures follow through with CCM's.
  • Develops ideas for performance improvement, service delivery, and cross-functional initiatives that contribute to department success.
  • Collaborates with the management team on new client implementation activities, including development/presentation of training materials, to ensure all home service center and client performance expectations are met.

What you Contribute?

Education:Registered Nurse with Bachelor's Degree and/or Master's Degree in Social Work or one of the other core mental health disciplines

Licensure: Current, valid and unrestricted license in a State or territory of the United States in a mental health field (RN, Ph.D., LCSW/ACSW, LLP, MHC, LPC, etc.). Current licensure must be maintained in the state where employed. Additionally, some client contracts will also require current licensure in the state in which their membership or consumer base resides.

Knowledge, Skills & Abilities:A minimum of five (5) years post graduate clinical/administrative experience, supervisory or team lead experience preferred.Requires solid knowledge base and working knowledge of mental health systems with clear understanding of psychiatric clinical case management and utilization review. Requires effective management and interpersonal skills. Must be able to articulate programs verbally and in writing as necessary.

What Makes Us Different?
  • Here, it's not just a job - it's an opportunity to change lives.
  • Our employees are learners, innovators and original
  • Our mission and values guide the way we treat our members, providers and each other.

What We Have to Offer:
  • Healthcare benefits available starting day 1!
  • Health & wellbeing incentives, such as gym membership reimbursement
  • 401K with company match to help reach your future financial goals
  • Generous PTO, because we know life happens outside of work
  • Tuition reimbursement so you can keep reaching your fullest potential

If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

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