Job Description

Join Southwest Behavioral & Health for exceptional growth opportunities driven by our promote-from-within philosophy. We provide an EXCELLENT compensation and benefits package, including immediate participation in our 403(b) program with 40% company match after 1 year of service. Generous Paid Time Off (PTO) includes 3 weeks of time-off your 1st year (available after 6 months) and increased vacation accruals after 2, 5 and 10 years of service! We offer low cost medical insurance and offer 100% company-paid dental, Short Term Disability, Long Term Disability, and Life coverage for employees. Other great benefits include 10 paid holidays, vision, licensure/certification reimbursement, tuition reimbursement, prescription drug discounts, chiropractic services, 100% paid Employee Assistance Program, and much more!

Southwest Behavioral & Health Services is a large and growing, non-profit community-based provider of behavioral health services with locations throughout the Phoenix metropolitan area, rural Maricopa County, Gila, Pinal, Mohave, Coconino, and Yavapai Counties. We are a well-established voice in the community with more than 115 sites, over seven hundred employees, and 40 years’ experience.

We are currently seeking a Quality Management Specialist to join our Quality Management team!

Works with Risk, Compliance and Program Monitoring departments to streamline data and provide support in performance improvement initiatives. Performs qualitative and quantitative data analysis regarding external and internal queries, incident reporting, compliance and BHMP billing standards. Will communicate qualitative findings with the QM Program Coordinator and provide a supportive role to all programs ensuring educational communication and response. Will communicate effectively with all insurance plans regarding external investigations and provide findings to QM Program Coordinator, Director of Risk Management and Chief Quality Officer. Will communicate effectively with Chief Medical Officer and QM Program Coordinator regarding Prescriber Data Validation Findings.

Duties & Responsibilities:

  • Coordinate and track all Insurer Investigation Responses and Corrective Action Plans, with all program levels within SBH.
  • Participate in ongoing Program Monitoring audits as determined by Director of Program Monitoring and QM Program Coordinator.
  • Complete exit meetings following each audit process to review results, discuss strengths and provide opportunities for improvement.
  • Available to assist in brainstorming improvements and assisting programs with developing action plans following audits.
  • Completes Focused Audits for CAP’s – Develops tracking sheets for QM “focused audit results” for CAP’s. Assist in the analytics of data collected and reported for these audits.
  • Complete Monthly Data Validation Audits for all BHMPs. Reviews audit findings with Chief Medical Officer monthly to ensure appropriate billing standards.
  • Completes Pre-Investigation Reviews on sentinel events, external grievance, board complaint and incident report trends. Details findings to QM and Site Leadership to ensure appropriate internal technical assistance will track completion.
  • Leads Pre-Litigation Meetings with QM and Site Leadership to review potential quality of care concerns and provide support in performance improvement initiatives.
  • Works in coordination with Risk to update CARF reports regarding Pre-Litigation findings.
  • Review all incoming Seclusion and Restraint forms for SBH inpatient teams. Leads monthly Seclusion and Restraint meetings with SBH. Offers technical assistance and training in areas of need.
  • Ensures compliance with company policies and procedures related to SBH expectations
  • Ensures fair, equitable and uniform practices and complies with all state, federal, funding source and regulatory bodies comply with established SBH best practices and policies and procedures.
  • Maintains confidentiality in all matters pertaining to employees and clients. Demonstrates professionalism, good judgment and tact when dealing with others.

Education & Qualifications:

  • Bachelor’s Degree in Business/Healthcare Administration or related field plus 3 years of progressive related experience required.
  • Must be proficient in Microsoft Programs with an emphasis in Excel and Database Administration

SB&H is a drug-free workplace, drug screening required. EOE

Join Southwest Behavioral & Health for exceptional growth opportunities driven by our promote-from-within philosophy. We provide an EXCELLENT compensation and benefits package, including immediate participation in our 403(b) program with 40% company match after 1 year of service. Generous Paid Time Off (PTO) includes 3 weeks of time-off your 1st year (available after 6 months) and increased vacation accruals after 2, 5 and 10 years of service! We offer low cost medical insurance and offer 100% company-paid dental, Short Term Disability, Long Term Disability, and Life coverage for employees. Other great benefits include 10 paid holidays, vision, licensure/certification reimbursement, tuition reimbursement, prescription drug discounts, chiropractic services, 100% paid Employee Assistance Program, and much more!

Southwest Behavioral & Health Services is a large and growing, non-profit community-based provider of behavioral health services with locations throughout the Phoenix metropolitan area, rural Maricopa County, Gila, Pinal, Mohave, Coconino, and Yavapai Counties. We are a well-established voice in the community with more than 115 sites, over seven hundred employees, and 40 years’ experience.

We are currently seeking a Quality Management Specialist to join our Quality Management team!

Works with Risk, Compliance and Program Monitoring departments to streamline data and provide support in performance improvement initiatives. Performs qualitative and quantitative data analysis regarding external and internal queries, incident reporting, compliance and BHMP billing standards. Will communicate qualitative findings with the QM Program Coordinator and provide a supportive role to all programs ensuring educational communication and response. Will communicate effectively with all insurance plans regarding external investigations and provide findings to QM Program Coordinator, Director of Risk Management and Chief Quality Officer. Will communicate effectively with Chief Medical Officer and QM Program Coordinator regarding Prescriber Data Validation Findings.

Duties & Responsibilities:

  • Coordinate and track all Insurer Investigation Responses and Corrective Action Plans, with all program levels within SBH.
  • Participate in ongoing Program Monitoring audits as determined by Director of Program Monitoring and QM Program Coordinator.
  • Complete exit meetings following each audit process to review results, discuss strengths and provide opportunities for improvement.
  • Available to assist in brainstorming improvements and assisting programs with developing action plans following audits.
  • Completes Focused Audits for CAP’s – Develops tracking sheets for QM “focused audit results” for CAP’s. Assist in the analytics of data collected and reported for these audits.
  • Complete Monthly Data Validation Audits for all BHMPs. Reviews audit findings with Chief Medical Officer monthly to ensure appropriate billing standards.
  • Completes Pre-Investigation Reviews on sentinel events, external grievance, board complaint and incident report trends. Details findings to QM and Site Leadership to ensure appropriate internal technical assistance will track completion.
  • Leads Pre-Litigation Meetings with QM and Site Leadership to review potential quality of care concerns and provide support in performance improvement initiatives.
  • Works in coordination with Risk to update CARF reports regarding Pre-Litigation findings.
  • Review all incoming Seclusion and Restraint forms for SBH inpatient teams. Leads monthly Seclusion and Restraint meetings with SBH. Offers technical assistance and training in areas of need.
  • Ensures compliance with company policies and procedures related to SBH expectations
  • Ensures fair, equitable and uniform practices and complies with all state, federal, funding source and regulatory bodies comply with established SBH best practices and policies and procedures.
  • Maintains confidentiality in all matters pertaining to employees and clients. Demonstrates professionalism, good judgment and tact when dealing with others.

Education & Qualifications:

  • Bachelor’s Degree in Business/Healthcare Administration or related field plus 3 years of progressive related experience required.
  • Must be proficient in Microsoft Programs with an emphasis in Excel and Database Administration

SB&H is a drug-free workplace, drug screening required. EOE

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online