Director of Clinical Quality Operations (Dir. Clinical Ops)

Cypress CA Beacon Health Options

Beacon Health Options

Job Category: Clinical – Quality Mgmt
Req #: DIREC01998
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 Director Clinical Quality Ops a highly organized and compassionate professional to join our team at our Cypress, CA. Functions as an integral part of the Clinical leadership team. Works collaboratively with the Clinical leadership team to implement new business, enhance clinical programs, clinical operations and other strategic initiatives. Analyzes key performance indicators, current policies and procedures and creates action plans to support compliance with client expectations, accreditation standards, regulations and strategic clinical goals.

What does a typical day look like?

  • Develops workflows, policies and procedures for provision of utilization management and care coordination activities.
  • Manages clinical implementation of new business, enhancement of clinical programs, clinical operations and other strategic initiatives.
  • Serves as project manager on clinical initiatives; defines project plan and deadlines and ensures appropriate engagement of downstream operational areas to clinical initiatives such as network, configuration, provider relations etc.
  • Tracks and prioritizes clinical projects in collaboration with the VP, Clinical Services. Intakes and triages new operational issues and facilitates next steps to ensure effective policies and procedures are in place.
  • Provides oversight of clinical operational activities; ensures clinical policies and procedures are appropriately updated, approved and operationalized internally; makes recommendations to senior leadership on clinical policies.
  • Represents Clinical leadership at internal and external meetings on clinical issues
  • Works with reporting to develop accurate and adequate data to effectively manage utilization and identifies targeted opportunities to improve performance; responsible for overseeing reporting of accurate data assigned to operational team.
  • In collaboration with the Clinical Leadership Team, utilizes data to evaluate current programming and to develop and implement new initiatives that address clinical operations goals.
  • Develops collegial relationships at local and corporate level as well as within the provider community, community agencies and the state to assure effective, efficient and coordinated utilization and case management activities.
  • Collaborates with VP Clinical services as well as the regional financial officers regarding administrative budget and medical cost ratio.
  • Monitors Clinical PG’s and KPIs, CAPs in collaboration with Clinical and Regional Leadership team.
  • In collaboration with the clinical leadership team supports audit process, including readiness review, file preparation/submission and policy review.
  • Oversee development and regional clinical training program.
  • Works with clinical teams to develop reporting necessary to monitor performance.
  • Develops and assist with updates to Program Descriptions, Program Evaluations and work plans.
  • Other duties as assigned
  • What you Contribute?

    Education: A minimum of a Master’s Degree in a related field (Business Administration, Healthcare Administration, behavioral sciences etc.);

    Post Graduate Degree in healthcare field; RNs will also be considered.

    Licensure:

    • Licensed behavioral health clinician/nurse (LCSW, LMFT, LPCC, RN, Ph.D. or PsyD.) Who has Certification as a Care Manager is preferred.
    • Current, valid and unrestricted clinical licensure required with proof upon hire.

    Knowledge, Skills & Abilities:

    • Minimum of 5 years managed health care experience. Preference will be given to candidates who have worked within a managed care health plan setting.
    • Senior-level experience with operations and UM; fluency in clinical operations and driving operational efficiencies; and understanding of regulatory and accreditation requirements necessary.
    • Strong interpersonal skills and good written and verbal communication skills.
    • Proficient computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint.

    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 thinkers.
    • 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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    To apply for this job please visit topspotjobs.com.