Quality Improvement Coordinator – Behavioral Health

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Analyze, develop, and oversee clinical quality improvement activities to ensure alignment with customer expectations.

• Lead initiatives focused on clinical quality.

• Review clinical data for appeals to assess the medical necessity of services.

• Prepare reviews and cases for appeals and fair hearings.

• Create and implement the behavioral health quality program description, work plan objectives, HEDIS measures, and program evaluation documents.

• Oversee Behavioral Health Performance Improvement Projects (PIPs).

• Maintain records, logs, and documentation, including communications, in compliance with NCQA and state standards and regulations.

• Investigate and address behavioral health quality of care complaints and grievances.

• Serve as a liaison for appeals and fair hearings.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• An Associate's Degree in Nursing or a related field of study is required.

• A minimum of 2 years of experience in Clinical Nursing or Behavioral Health is required.

• At least 1 year of experience in Quality, Managed Care, or Healthcare Administration is required.

• Experience in the Behavioral Healthcare field is preferred.

• Certification as a Registered Nurse (RN), Licensed Mental Health Professional (LMHC), or Licensed Professional Counselor (LPC) is required.

• Must comply with NCQA and state standards and regulations, including adherence to timelines.

• Adherence to all policies and standards is mandatory.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement assistance.

• Paid time off in addition to holidays.

• Flexible work options, including remote, hybrid, field, or office work schedules.

• Additional forms of incentives may be included in the total compensation package.