Behavioral Health Provider Quality Manager (field)

Elevance Health•Seven Fields, PA

15h•Hybrid

About The Position

This is a field role covering northwestern and southwestern Pennsylvania. When not in the field, the associate will work virtually from home. This individual contributor role is responsible for leading Behavioral Health (BH) provider engagement, with a focus on leveraging data to improve the value delivered to members. The role drives BH provider performance improvement year over year through education and data, specifically for a local market. It involves establishing relationships with BH providers, ensuring measurable improvements in clinical and quality outcomes for members, and building relationships with internal clinical and quality departments to ensure high-quality care and achievement of company HEDIS performance. The position implements strategies to meet clinical, quality, and network improvement goals through positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders. It also supports regional and corporate initiatives regarding Alternative Payment Models (APM), clinical innovation, and thought leadership.

Requirements

MA/MS in a Behavioral Health field
Minimum of 10 years of professional experience in healthcare which includes a minimum of 5 years experience in a behavioral health setting
Current, valid, independent, and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist issued by the Commonwealth of Pennsylvania

Nice To Haves

Previously quality experience
Experience analyzing and interpreting data
Proficiency in Microsoft applications, especially Excel
Managed care experience

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 through positive working relationships with providers, state agencies, advocacy groups and other market stakeholders.
Meets with providers face to face, telephonically and via Teams.
Acts as a liaison between strategic providers and organization to ensure interdepartmental collaboration and coordination of goals.
Supports regional and corporate initiatives regarding Alternative Payment Models (APM), including Value Based Payment (VBP), clinical innovation, and thought leadership.
Creates and maintains linkages between providers of all levels of care, as well as other community-based services and resources.
Partners with network providers and organization stakeholders to operationalize innovative programs and strategies 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 or payment models.
Collaborates with regional leadership and network teams to identify providers who are best suited for APMs, preferred provider networks, and/or other aggregate data management programs.
Participates in the identification of opportunities for expansion and development of innovative pilot programs.
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 provider orientations and provider training events in the region, when applicable.