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Job Profile Summary:
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The QM BH Consultant reviews documentation and interprets data obtained from clinical records or systems to document root cause of high utilization of care. The QM BH Consultant develops and implements data-driven strategies/interventions that ensure the delivery of time sensitive behavioral health benefits and services for members. This position will require manipulation and analysis of data to support behavioral health initiatives on the quality management team.
Responsibilities include:
- Support record collection and review of case and medical records for behavioral health quality activities, including root cause analysis of high utilizer of behavioral health services.
- Report audit or clinical findings to state regulators, QM leaders, and other appropriate staff to ensure appropriate outcome and/or follow-up for improvement as indicated.
- Support behavioral health outreach activities, including supporting team outreach activities and reporting of outcomes.
- Help determine strategy for behavioral health activities with behavioral health quality team, including through review and analysis of behavioral health data.
- Manage data flows to and from the quality team for behavioral health reporting requirements under the Medicaid or CHIP contracts.
- Conducts quantitative and qualitative analyses to assess business performance and identify opportunities for improvement.
- Collects and analyzes business data to identify trends, patterns, and insights.
- Develops basic process maps, flowcharts, and diagrams to document as-is and to-be processes.
- Assess current practice patterns, assets and challenges utilizing HEDIS, CAHPS, state, and regulatory standards
- Manages HEDIS reporting including monthly updates, review of specifications, managing performance of contract HEDIS measures.
- Must reside in FL
- Active clinical behavioral health license in FL i.e. Licensed Mental Health Counseling, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, or Licensed Professional Counselor
- 3+ years of clinical experience in behavioral health or mental health
- Experience with Medicaid managed care
- HEDIS experience
- Experience working with SUD and/or SMI
- Proficiency in all Microsoft office Suite, especially Microsoft Excel and PowerPoint as well as Tableau and/or PowerBI or similar dashboarding software
- Statistical analysis skills and able to analyze and interpret data
- Exceptional communication skills (verbal, written) and ability to present information in various settings
- Ability to work independently, multitask, prioritize deliverables, and effectively adapt to fast-paced changing environment
- Must be articulate and able to communicate to multiple internal and external stakeholders
- Masters degree in the Behavioral health or Mental health field required
The typical pay range for this role is:
$54,095.60 - $116,760.80
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 01/04/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.