Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of our Topeka OR Olathe, Kansas Elevance Health PulsePoint locations.
The Critical Incident Program Consultant is responsible for the development and ongoing management of one or more external client facing programs within a business unit. Program consultants typically support business strategies through an integrated portfolio of external client facing projects or initiatives.
How you will make an impact:
Primary duties may include, but are not limited to:
Manages the development, approval, implementation and compliance of on-going external client facing programs; develops program budget; ensures program meets its stated objectives; provides subject matter expertise in response to day to day business issues.
Researches applicable subject matter practices and remains aware of industry trends.
Manages relationships and partners with corporate and regional business areas; coordinates training related to the external client facing program; develops program success measures and performs periodic assessments of external client facing program success.
Manages centralized critical incident email inbox
Validates compliance with critical incident protocols
Responsible for the tracking and processing of critical incidents, as well as any remediation activities and follow-up reports.
Makes a report to Adult Protective Services (APS) for incidents involving suspected abuse, neglect, or exploitation.
Makes a referral to Grievance and Appeals when a potential quality of care concern is identified.
Notifies the Member Privacy Unit (MUP) of privacy disclosures when external agencies such as law enforcement are contacted.
Identifies potential cases of fraud, waste, and abuse and makes appropriate referrals.
Manages regulatory reporting related to critical incidents including weekly reporting to the State partner.
Tracks and responds to untimely reporting of critical incidents.
Tracks and trends critical incident data on a monthly, quarterly and annual basis and identifies opportunities for improvement in protecting the health, safety, and welfare of members.
Collaborates with Network Relations, Quality, and Grievance and Appeals on identifying and supporting provider corrective action plans.
Collaborates with the State partner in analyzing critical incident patterns and trends.
Data mines and reviews claims reports to identify potentially unreported critical incidents.
Completes critical incident reporting for unreported incidents.
Provides education to the care coordination team in coordination with the training specialist in recognizing and screening for signs of abuse, neglect and exploitation (ANE); identifying individuals at risk of ANE; reporting ANE and critical incidents; and providing members and caregivers educational materials and resources on ANE.
Stays up-to-date on industry standards and requirements for ANE and critical incident reporting and prevention.
Participates in review and audits conducted by the State partner of the critical incident process which may include reviewing policy and procedures, workflows, and data.
Minimum Requirements:
Requires a BA/BS in a related field and minimum of 3 years experience in external client facing program management; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
For the Behavioral Health organization, lived experiences with behavioral health programs is strongly preferred.
Graduate degree, professional designation related to field or project management experience preferred.
