Quality Reviewer, Public Health Insitute
The Public Health Institute (PHI) is an independent, nonprofit organization dedicated to promoting health, well-being and quality of life for people throughout California, across the nation and around the world. As one of the largest and most comprehensive public health organizations in the nation, we are at the forefront of research and innovations to improve the efficacy of public health statewide, nationally and internationally. PHI was distinguished as one of the top 50 “Best Non-profit Organizations to Work For” by the Non-Profit Times in a national search.
PHI is seeking a Quality Reviewer for the Behavioral Health Concepts, Inc. This position is located in Emeryville, CA.
Behavioral Health Concepts (BHC), a program of the Public Health Institute, is seeking qualified candidates for the position of Quality Reviewer to work for the California External Quality Review Organization (CalEQRO) under a contract from the California Department of Health Care Services (DHCS). Centers for Medicare and Medicaid Services (CMS) requires external quality review of each of the 56 County Mental Health Plans (MHP) and each of the new Drug MediCal Organized Delivery Systems (DMC-ODS) in California on an annual basis. This involves reviewing multiple aspects of Substance Use Disorder and Mental Health treatment programs and operations to assess the plan beneficiaries’ access to services, quality of care, and timeliness of receiving services.
Following the reviews, the EQRO contract also provides for technical assistance and support to the 56 County Mental Health Plans and Drug MediCal Organized Delivery Systems for their Performance Improvement Projects (PIPs) and QI processes.
The ideal candidate will combine in-depth understanding of public mental health, substance use service delivery, and quality management systems. Ideally, this experience will also include work in quality review approaches, program evaluation, and excellent analytical and report writing skills.
Duties & Responsibilities:
- Conduct 8-16 DMC-ODS and MHP reviews each fiscal year (July 1 - June 30)
- Plan with and coordinate team members for conducting county-based Mental Health Plan (MHP) and Drug MediCal Plan (DMC-ODS) reviews under CalEQRO.
- Prepare and issue review notification packets at least 60 days in advance of on-site review.
- Work with the identified Mental Health and Drug MediCal contact person(s) prior to on-site review to determine review agenda and logistics.
- Conduct a thorough review of documents submitted by the MHP and DMC-ODS programs prior to on-site review.
- Conduct on-site review with other review team members for 1 to 5 days based on MHP or DMC-ODS size.
- Prepare a draft report for submission to DHCS that triangulates information from multiple sources, uses analytical reasoning, substantiates all findings logically and adequately, and makes appropriate recommendations for improving access, timeliness, and quality.
- Interact with DHCS and the MHPs and DMC-ODS Plans on an as-needed basis including attending occasional statewide meetings related to quality and performance improvement.
Technical Support and Quality Assurance (20%)
- Conduct quality reviews of draft reports to ensure standardized language, analyses and recommendations.
- Support development of tools and resources for County MHPs or DMC-ODS Plans.
- Assist with quarterly newsletters providing technical updates and EQRO findings (data) to all County MHPs and DMC-ODS Plans.
- Provide direct technical support on PIPs and QI processes and performance measures for all 56 County MHPs annually and for DMC-ODS Plans
- Participate in NCQA and ASAM activities as relevant to the California EQRO contracts as well as relevant CIBHS trainings and conferences.
- Collaborate with state and national QI entities to leverage knowledge, resources, and approaches for best performance measures and metrics linked to quality.
- Assist with other support as needed.
- Ability to lead 3-6-member review teams.
- Superior organizational skills.
- Excellent analytical reasoning skills.
- Excellent report writing skills.
- Excellent computer skills related to word processing.
- Excellent communication skills, including the ability to properly interact with MHP or DMC-ODS staff of all levels from executive management to line staff and beneficiaries served.
- Quick thinking and problem-solving skills as needed on-site.
- Behavioral health service delivery and/or quality improvement work in public behavioral health settings.
- Systems-level understanding of behavioral health or health care delivery including clinical, administrative, operational, and fiscal and information systems.
- Understanding of current trends in behavioral health and health care systems especially in California (examples include wellness and recovery, cultural competence, whole person care, Affordable Care Act and Medi-Cal expansion, dual eligibility (Medi-Medi), care integration, MHSA programs, HEDIS, NQF, IOM, CMS quality and performance measures, and meaningful use).
- Evaluation or review report writing experience.
- Experience conducting focus groups and interviews.
- Experience making presentations in large group settings.
- Ability to do extensive travel within California - up to 25% of time.
- Must have available transportation and ability to commute to various locations other than the assigned office.Ability to drive long distance depending on the county being reviewed.
- Ability to travel up to 7,500 feet altitude depending on the county being reviewed.
- Ability to travel by plane depending on the county being reviewed.
Any or a combination of the following:
- A Master’s or Ph.D. in Psychology, Social Work, Nursing, Public Health, Education, or a closely related field.
- A clinical license in psychology, social work, marriage and family therapy, or nursing.
- Accreditation in any aspect of health care quality improvement, quality review, or performance management (examples include HEDIS certification, CPHQ, LEAN, Six Sigma, etc.).
- Addiction Medicine board certification or credentials.
- SUD credentials for the State of California as an SUD counselor, peer, etc.
- Car rental, hotel stays, staying within allowed per diem for meals while on review are standard practice for review trips.
- Some telecommuting may be allowed with supervisor’s prior approval.
- Full and part time positions available starting Fall 2017.
This is an exempt position and the salary is commensurate with experience. PHI offers a generous benefits package including medical, dental, vision, short/long term disability insurance, life insurance, 403b (group retirement annuity) and partial subsidy of public transportation cost. For more information about PHI’s benefits, visit our benefits page at https://www.phi.org.
How to apply:
To apply for this position visit our Career Site at https://www.phi.jobs.
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