SHIFT: Day Job
Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it's a powerful combination. It's the foundation upon which we're creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
Location: Bridgewater, MA. Can be REMOTE. Must live within 60 miles or 1 hour of the Bridgewater office.
State of MA Behavioral Health License required for this role.
The Behavioral Health Provider Quality Manager - Emergency Services position will be responsible for leading Behavioral Health (BH) provider engagement, with a focus on leveraging the data available to providers and helping to improve the value delivered to Beacon members. Drives BH provider performance improvement year over year through education and data. This role is responsible for a local market.
What does a typical day look like?
Primary duties may include, but are not limited to:
- Primary duties may include, but are not limited to:
- Establishes relationships and engages with Emergency Service Providers and ensures measurable improvements in clinical and quality outcomes for members.
- Builds relationships with internal clinical and quality departments to ensure high quality care to members and achievement of company HEDIS performance.
- Implements strategies that meet clinical, quality, and network improvement goals through positive working relationships with providers, state agencies, advocacy groups and other market stakeholders.
- Meets with ESP providers face to face, telephonically and via Web-Ex.
- Acts as a liaison between strategic ESP providers and Beacon clinical, quality, provider strategy, network departments, operations, claims and provider relations to ensure interdepartmental collaboration and coordination of goals and priorities and to support linkages for issue resolution, helping to improve provider experience and overall satisfaction with Beacon.
- Supports regional and corporate initiatives regarding Alternative Payment Models (APM), including Value Based Payment (VBP), clinical innovation, and thought leadership transforming provider relationships from transactional interactions to collaborative aggregate data assessment.
- Creates and maintains linkages between ESP providers and providers of all levels of care, as well as other community based services and resources to improve transitions of care and continuity of services.
- Partners with network providers and Beacon stakeholders to operationalize innovative programs and strategies to improve clinical and quality outcomes.
- Analyzes ESP provider reports pertaining to cost, utilization, and outcomes, and presents the data to providers and highlights trends.
- Identifies data outliers and opportunities for improvement for individual ESP providers. Identifies high-performing and innovative providers who may be interested in new programmatic or payment models.
- Participates in the identification of opportunities for expansion and development of innovative pilot programs, to include program development, implementation, launch, and efficacy and outcomes measurements.
- Contributes to the identification of best practices and integrates high-quality program ideas/designs into the local market to drive high levels of value.
- Provides consultation to providers for clinically complex members as applicable. Surfaces clinical and quality issues to regional clinical and quality teams and participates in helping to address concerns.
- Conducts medical record reviews annually or as needed with network providers across all service levels.
- Assists with ESP provider orientations and ESP provider training events in the region, when applicable.
What You Contribute:
- Requires Master's degree or above in Behavioral Health field; 10 years of progressively responsible professional experience in healthcare, with at least 5 of those years in a behavioral health setting, either provider or payer; or any combination of education and experience, which would provide an equivalent background. Managed care experience preferred.
- Current, valid, independent and unrestricted MA state license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable by state laws) is required.
- Emergency services program experience preferred.
- Travel may be required.