QA Analyst

Responsibilities:

• May work with UM clinicians to review patient compliance with treatment plan, identify obstacles to compliance and develop action plans.
• May collect information on patient progress and adherence to treatment plan.
• Provide information to members regarding mental health, community treatment resources, mental health managed care programs, and Aetna policies and procedures.
• May follow-up with members regarding missed aftercare appointments.
• May follow-up with outpatient providers to assure timely outpatient follow-up appointments for patients discharged from the hospital.
• Participate in reporting activities including data collection, tracking, analysis and preparation.
• Activities may include QI initiatives, post discharge and recidivism follow-up reporting, review and analysis of quarterly recidivism reports for quality improvement reporting.

Qualifications:

• 1+ years working in behavioral health setting or prior managed care experience.
• Position requires proficiency in operating a Windows based computer which includes navigating multiple systems at the same time.
• Work requires sitting/standing for extended periods, exemplary telephone skills and proficiency in keyboarding.

Key Skills:

• Knowledge of a broad range of software applications and of hardware and networks.
• Strong programming knowledge.
• Mathematical skills.
• Problem-solving skills.
• A good understanding of business.
• Ability to think in the abstract and see how small details fit into the bigger picture.

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