Quality Manager (Remote)

About Brave Health:

Nearly 1 in 4 people in the U.S. get their healthcare coverage through Medicaid, but nearly two thirds of psychiatrists don’t accept Medicaid. This gap has only grown larger over time, creating a clear opportunity for a model that delivers critical mental health care at scale. Brave is on a mission to expand access to high-quality, affordable behavioral health care through a fully virtual community mental health center model, with a differentiated approach to serving Medicaid beneficiaries. Through telehealth services we are able to reach those in need, when and where they need it.

Job Overview:

As a Quality Manager you will focus on maintaining an excellent quality program for Brave Health including policies, procedures, metrics and oversight. Your duties will include internal governance activities, including facilitating quality management meetings, EMR support, compliance with company goals, patient complaint/grievance escalation, incident reporting, CARF accreditation, policy and procedure development & oversight, clinical measure management, and tabletop drill management. Ensure providers are performance managed and given feedback or coaching plans for patient incidents and quality themes. Additionally, you will collaborate with other leaders on projects and initiatives including quality improvement projects that meet strategic goals with our health plan partners.

Key Responsibilities:

Oversee Quality Management:

• Oversee Brave’s Quality performance initiatives.
• Facilitate quarterly Quality Management meetings and follow-up on action items.
• Own the entire Incident reporting process including tracking of timelines, analysis, and external reporting.
• Own Sentinel event reporting process including tracking of timelines, root cause analysis and external reporting.
• Own the entire Grievance process including tracking of timelines, reporting and analysis.
• Own driving follow through of provider quality themes or incidents with provider supervisors and HR when appropriate e.g. above normal patient requests for switching providers with recurring themes, or providers delinquent in Training compliance.
• Manage the Policy and procedure review process, ensuring the policies are reviewed annually at a minimum. Create policies as needed. Ensure policies meet all oversight entity requirements.
• Liaise with HR and Training on Handbook dovetail requirements, auditable record keeping requirements, and mandatory trainings.
• Define and document our quality clinical quality strategy, success measures, and management practices.
• Serve as leader and champion for clinical outcomes initiatives and measurement.
• Consult with the Account Management team on initiatives that help us meet our partners’ quality goals, e.g. FUH, ED/ACSC admissions reduction, follow up for children receiving ADHD rx (FL)
• Drive identification of key quality risks and proposed mitigations related to Brave’s expansion plans
• Participate in audits, both internal and external.
• Develop business requirements for quality monitoring dashboards and tools.
  
  
  

EMR Support:

• Ensure compliance with EMR usage and support medication team goals.
• Serve as SME for EMR product development and vetting of additional solutions.
• Conduct user testing as needed
• Update policies accordingly
  
  
  

Incident Reporting and Patient Complaint / Grievance Escalation:

• Handle all sentinel and incident reporting and manage patient complaint escalation. This includes thorough investigation to identify performance improvement opportunities.
• Report out to the Quality Management Team, providing any recommendations as needed.
• Update policies accordingly.
  
  
  

CARF Accreditation:

• Own the CARF accreditation relationship, monitor ongoing performance / compliance and fulfill requirements.
• Ensure Brave adheres to current CARF standards
• Prepare and manage the end to end audit process.
• Update policies accordingly.
  
  
  

Policy & Procedure Oversight:

• Manage annual review of all policies, procedures and protocols
• Create policies as needed and liaise with other teams e.g. IT, HR, Training to ensure sister policies exist where required e.g. Handbook, Cyber training and policies/HIPAA, training compliance.
• Initiate and manage clinical measures tracking and oversee policy and procedure adherence.
• Ensure all policies meet oversight entity requirements.
  
  
  

Table Top Drills:

• Create and manage monthly tabletop drills for team preparedness.
• Ensure all identified performance opportunities are implemented.
• Collaborate with various department leaders to identify tabletop drill scenarios.
• Report out to the Quality Management Team, providing any recommendations as needed.
  
  
  

Compliance Oversight:

• Ensure compliance with provider essential duties and assist with appointment outcomes, billing/coding submission.
• Serve as liaison with the Compliance team for monthly medication management peer review audits and related performance improvement interventions.
• Conduct monthly chart reviews to ensure compliance with standards and best practices are being met. Communicate recommendations to supervisors and Quality Management Committee as needed.
• Participate in routine and ad hoc audits, internally and externally.
• Research and communicate federal and state regulations regarding provider licensure and collaborative agreements / ratio requirements.
• Serve as SME in conjunction with Chief Medical Officer on prescribing regulations and requirements including federal and state (DEA / CDS).
  
  
  

Qualifications:

• Excellent record as a currently licensed mental health provider (RN, Therapist, Nurse Practitioner).
• At least 3 years of people leadership experience.
• At least 5 years of administrative role work with oversight over quality policies and procedures, preferably at an accredited organization.
• Proficient navigating EMRs
• Experience owning an investigation process.
• Experience working cross functionally in a business to collaborate with partners e.g. Training, HR, Partnerships.
• Strongly prefer experience owning metrics and demonstrating where you studied data to gain insights then took action.
• Experience monitoring and measuring behavioral health quality measures and/or with eCQM
  
  
  

Metrics for Success:

• All relevant SLAs are met (e.g. grievance reporting timelines; external reporting of sentinel events, provider feedback themes are followed up on with clinical supervisors and providers to improve quality, audit pre and communication cross functionally is excellent as viewed by audit participants etc)
• CARF renewal, no significant deficiencies
• Audit standard of 90% compliance met or at least improvement shown month over month with performance improvement plans in place and monitored.
• P&Ps reviewed annually and tracker up to date
• Key clinical quality measures tracked, monitored and improved month over month with performance improvement plans in place (HEDIS measures, mental health screening tools, additional measures TBD)
• Brave leadership has strong real time visibility into our performance against quality metrics via self-serve dashboards and tools
• Brave has a roadmap for managing additional quality metrics and can report to internal, board level, and external stakeholders on this plan.