Behavioral Health Quality Assurance SpecialistJob Title: Behavioral Health Quality Assurance Specialist
Department: Thurmond Tanner
Under general to limited supervision, the Quality Assurance Manager works with other departments, as needed, to evaluate the medical necessity, appropriateness and effectiveness of paraprofessional behavioral health services provided for the purpose of maintaining quality care through judicious use of resources.
•Coordinates and performs service eligibility authorization review, quality assurance and billing compliance audits, service access, and continued stay reauthorization reviews.
•Acts as liaison between Avita service providers and third-party payers, managed care organizations, and external review organizations as needed in the performance of utilization and quality assurance management..
•Provides reports for internal and external use for performance evaluation and improvement.
•Interprets National and State standards, rules, regulations, and best practice guidelines relevant to Avita programs, policies, standards, and guidelines on corporate compliance, utilization management, and quality assurance.
Must have a bachelor’s degree in a social science.
*Experience in Behavioral Health Care utilization management/utilization review and or quality assurance, and experience using computer applications such as word processing, electronic health records, spreadsheets, and other database management software.
Avita Community Partners is an Equal Opportunity Employer and does not discriminate in its service practices or employment practices with regard to race color, religion, disability, gender, sexual orientation, age, or national origin.
The selected candidate will be subject to a FBI Criminal History Record Check. Applicants reserve the right to challenge the contents of a FBI Criminal History Record Check.
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