Remote VA CCN Clinical Quality Patient Safety Specialist – Behavioral Health (United Healthgroup) 166 views

Job Overview

  • Specialty License RN, LCSW
  • State License (Select 'ANY' & Your State) Any

This position works under the direction of the CQM Manager. The individual in this role will focus on investigating behavioral health potential quality issues, patient safety events, and sentinel/serious reportable events and utilization issues by conducting retrospective chart and focused reviews.  Participate on quality committees.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Identifies and reviews behavioral health and occasional medical surgical potential quality issues (PQIs), patient safety issues, sentinel events and serious reportable events by applying best practice standards of care and clinical experience
  • Conducts timely reviews of electronic medical records to meet Optum standards
  • Investigations include research, analysis, and preparation of written and verbal case summaries with recommendations for further actions as necessary
  • Works predominately in Microsoft Office products (Word, Excel, Power Point), Visio, and quality databases to track and trend quality issues
  • Conducts root cause analysis for sentinel events and serious reportable events
  • Organizes and maintains current investigation information about cases through documentation in quality of care and quality of service databases
  • Communicates in writing to health care providers, track timelines, and performs follow – up as appropriate
  • Develops peer review cases and other quality improvement activities identified by deviations from accepted standards of care and monitors corrective action plans to completion
  • Assists in the compilation of trending data and quality reports for presentation at CQM Committees
  • Assists with quality studies and focused reviews by abstracting medical records for specified criteria
  • Participates in quality committees and presents cases to peer review quality management committee
  • Develops peer review cases and other quality improvement activities
  • Collaborates with Medical Directors on quality issues as needed
  • Reads, interprets, and documents standards/requirements and / or technical specifications (e.g.,NCQA, NQF, WinQi, HAC)
  • Works with stakeholders for review / approval of results
  • Actively participates in meetings
  • Trains others on relevant policies, rules and regulations
  • Serves as a resource providing explanation and expertise
  • Maintains confidentiality and non – discoverability of all activities
  • Performs all other duties as assigned

Required Qualifications:

  • LCSW or RN with current, active license without restriction in required state(s)
  • 3+ years of behavioral health (inpatient / outpatient / partial hospitalization program / residential treatment center) experience
  • 1+ years of clinical quality management experience or equivalent
  • Prior medical record chart abstraction and peer review experience
  • Ability to investigate, analyze, synthesize, and formulate conclusions for multiple sources of complex data
  • Strong computer skills with emphasis on Microsoft Office software (Windows, Word, and Excel) and databases
  • Ability to organize quality data in appropriate reporting formats

Preferred Qualifications:

  • BSN
  • General knowledge of Medicare, VA, TRICARE, or other government health care program
  • Prior quality experience within a managed care organization
  • Excellent interpersonal, communication and writing skills
  • Ability to work in a fast paced dynamic environment; Adaptable and flexible
  • Detail oriented, highly organized, and manages time effectively

*This is an external posting. Remote Medical Jobs has no affiliation with the company and no further information on the position. I simply find and share these jobs to the community. If interested, please apply to external link*

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Remote Medical Jobs is a space designed to help medical professionals find work-from-home jobs. I am a nurse who works from home and, like a lunatic, I spend all my free time helping others do the same. Happy hunting!