Behavioral Health Community Partnership Manager - Humboldt County

Elevance Health•Eureka, CA

1d•Hybrid

About The Position

Behavioral Health Community Partnership Manager (Behavioral Health Provider Quality Manager) Sign on Bonus: $2,500 Candidates must posses a licensure for the state of California. Location: The ideal candidate MUST reside in Humboldt county. This role enables associates to work virtually as well as in the field for client visits, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face meetings. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. This position will be required to travel out to the field in Northern California (Humboldt County). Schedule: Pacific Standard Time A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges. The Provider Quality Manager is 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 Carelon members. Drives BH provider performance improvement year over year through education and data. This role is responsible for a local market.

Requirements

Requires MA/MS or above in Behavioral Health field and a minimum of 10 years of progressively responsible professional experience in healthcare which includes a minimum of 5 years’ experience in a behavioral health setting, either provider or payer; or any combination of education and experience, which would provide an equivalent background.
Current, valid, independent, and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable by state laws) is required.

Nice To Haves

Behavioral Health experience preferred.
Managed care experience preferred.
Travels to the worksite and other locations as necessary.

Responsibilities

Establishes relationships and engages with BH 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.
Build positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders.
Meets routinely with strategic providers face to face, telephonically, and via Web-Ex to support provider training on Carelon processes, contracting / credentialing and linkages for issue resolution, helping to improve provider experience and overall satisfaction with Carelon.
Acts as a liaison between strategic providers and Carelon clinical, quality, provider strategy, operations, and claims, to ensure interdepartmental collaboration and coordination of goals and priorities.
Supports regional and corporate initiatives regarding Carelon Select Provider (CSP) program, clinical innovation, and thought leadership transforming provider relationships from transactional interactions to collaboration.
Creates and maintains linkages between 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 Carelon stakeholders to operationalize innovative programs and online resources to improve clinical and quality outcomes.
Analyzes 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 providers.
Identifies high-performing and innovative providers who may be interested in new programmatic incentives or payment models.
Participates in the identification of opportunities for expansion and development of innovative pilot programs, implementation, launch, and efficacy and outcomes measurements.
Contributes to the identification of 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 quarterly physician record reviews or as needed with network providers across all service levels.
Assists with provider orientations and provider training events in the region, when applicable.
Attends all accessible County BH provider meetings either in person or via telephone or Web-ex.