Remote Specialist, Quality Management (RN) – Florida

Job Overview

  • Clinical License RN
  • State(s) FL

Full job description

Who We Are

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our mission – and our passion – is to improve the lives of the members we serve and be the ideal partner for our providers.

Lucet’s unique combination of people and technology has proven to optimize access to behavioral health care providers and increase a health plan’s ability to connect members to quality care. With the industry’s largest network of care navigators and technology powered by more than six million assessments and more than 20 years of data, Lucet is the only solution proven to successfully identify and connect people across the entire acuity spectrum with the right care in less than five days on average, and often as little as one day.

Our members, providers and partners fully entrust us to deliver outstanding quality care through coordinated behavioral health services, employee assistance programs, organizational consulting, student well-being programs and more.

When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others – and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you’ll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.

Job Summary

The Quality Management Specialist is responsible for the coordination of Quality Management functions including URAC and NCQA accreditation initiatives, reports, and analysis, plan specific and corporate level performance improvement initiatives, and presentations to committee members, health plan and management staff. Responsibilities also include research and design of studies, facilitation of teams and workgroups, conducting gap analysis, root cause analysis, developing recommendations, and establishing monitors. QM Specialist may also help with complaint and incident handling, This position requires knowledge of quality tools and the ability to simultaneously manage multiple projects which may require collaboration with Clinical, Network Operations, IT and Data Analytics departments as well as management. The QM Specialist is responsible for clearly written quarterly and annual reports, work plans, program descriptions and monitoring compliance. The QM Specialist requires strong analytic and critical thinking skills and the ability to translate data into actionable information.

Essential Functions

  • Manage projects as assigned: develop, design, analyze, direct and present the projects to various customers. Identify opportunities for improvement and take action to address the identified gaps.
  • Support and guide projects with management staff and line staff in other departments to achieve results. Participate in multidisciplinary regional workgroups, teams, and committee meetings for projects, reporting and in an advisory role.
  • Perform data collection and quantitative and qualitative analyses used for QM reports and audits; departmental and improvement teams; and accreditation. Use statistical analyses as appropriate.
  • Prepare and present reports for the purpose of the customer reporting; internal meetings; external auditors; external meetings with providers; senior executives; Board of Directors; external customers and employers, etc.
  • Manage complaint investigations and resolution processes professionally, confidentially, collaboratively and timely as assigned
  • Write and maintain QM Department policies and desktop procedures. Write procedures, and train staff on the policies and procedures as requested for QM assignments. Collaborate and communicate changes with key stakeholders.
  • Assist with accreditation preparation and development of reports/deliverables. Coordinate accreditation projects with other departments and operations teams through consultation and facilitating workgroups, teams, and departments implementing and monitoring accreditation standards.
  • Participate in health plan specific and corporate performance improvement initiatives as a team member, facilitator, or subject matter expert. Use performance improvement methodology and tools to facilitate change initiatives.
  • Adheres to Lucet Mission Statement, Core Values, Code of Business Conduct and Compliance Program

Job Qualifications

Required

  • RN license and/or Bachelor’s Degree in health related field with 2 or more years of Quality Management, Performance Improvement, behavioral health clinical services or auditing experience in healthcare setting
  • Intermediate level of knowledge of quality management principles, study design, data analysis, and report preparation
  • Demonstrated strong analytical skills, critical thinking, problem solving capabilities and mathematical skills
  • Strong written communication skills including routine ability to compose correspondence, memos, and reports, with text tables and graphics as required.
  • Intermediate skills with Microsoft Office (Word, Excel, Power Point and Outlook) and Visio
  • Critical thinking and analytical skills; able to decipher best practice research with statistical discrimination, design audits and surveys.

Preferred

  • Clinical license and experience
  • Behavioral health managed care experience highly preferred
  • Lean Six Sigma certified (Green belt or higher) or CPHQ certified
  • Master’s degree
  • 2 or more years of Performance Improvement leading or facilitating small to moderate initiatives
  • 2 or more years of experience in accreditation or regulatory compliance
  • Willing to obtain QM certification within 18 months of hire if not already certified

Key Competencies

  • Ability to read, analyze and interpret technical journals, financial reports, and legal documents.
  • Excellent writing ability for presentations and reports and uses prescribed style and format as needed by accrediting/licensing bodies.
  • Ability to conduct quantitative and qualitative analysis and effectively present information to all levels of management, public groups, and/or Boards of Directors.
  • Ability to deal with a variety of abstract and concrete variables.
  • Ability to identify key in-process and outcome measures for projects
  • Ability to identify and interpret basic statistical analyses, charts, and graphs to identify success or opportunities for improvement within assigned programs

Working Conditions

  • Work is performed indoors in a remote, home setting or typical office environment – not substantially exposed to adverse environmental conditions.
  • Frequent exposure to VDT screens, video calling, headphones, and computers.
  • Physical demands include constant ability to remain in a stationary position, move about inside an office or remote setting, able to communicate and exchange information with others, able to inspect information, and able to perform repetitive motion with arms and fingers.
  • Mental demands include constant ability to interpret data, problem solve, make decisions, and organize and plan.

Salary and Other Compensation:

The starting salary that Lucet reasonably expects to pay for this position ranges from $68,000 – $80,000 annually, depending on circumstances including an applicant’s skills, education/degrees, certifications, prior experience, market data, and other relevant factors.

This position is eligible for a bonus in accordance with the terms of Lucet’s incentive plan based on both company performance and individual performance.

Benefits: The Company offers the following benefits for this position, subject to applicable eligibility requirements: Medical, Dental, Vision, 401(k) with competitive employer match, company paid life and disability insurance, company paid gym access, tuition reimbursement, parental leave, PTO (vacation, sick and volunteering), Remote Work.


This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.

 

 

 

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