Senior Director Of Quality Management
CurrentResponsible for the management of day-to-day quality management activities of the Managed Care Organization for Lackawanna, Luzerne, Susquehanna and Wyoming Counties.Coordinate with the Managed Care organization and provide oversight of their functions related to: Network Management, Member Services, Care Management and Quality Management.Works in conjunction with the Consumer and Family Satisfaction team to ensure member feedback and input into the Health Choices program.Monitor the Complaints and Grievance process as required by the Office of Mental Health and Substance Abuse Services (OMHSAS).Successfully participated in the development and management of over 10 million dollars in reinvestment projects.Participate in inspections and investigations of Mental Health and Substance abuse facilities.Oversee Quality Management chart and documentation reviews for Mental Health and Substance Abuse providers.Leader in the development of pay-for-performance initiatives.Compiles and submits reports on the Health Choices program as required by the Office of Mental Health and Substance Abuse Services (OMHSAS).Review all Significant Member Incident reports, Provider Benchmark issues and denials. Assess the need for further intervention, training or education.Review weekly and monthly Behavioral Health Rehabilitation Services utilization reports to identify trends and provide guidance for corrective measures.Recommends and monitors performance improvement projects.