Population Health Specialist, ABA services - Hybrid (PA/NJ/DE)

Blue Cross and Blue Shield Association-posted 4 months ago
Hybrid • Philadelphia, PA
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The Population Health Specialist for Autism /Applied Behavioral Analysis (ABA) Services leads initiatives and programs to enhance access and quality, across multiple provider types, access channels and in collaboration with other IBC quality, population, and value initiatives. Supports behavioral health leadership in implementing initiatives in multi-year strategy to enhance behavioral health services and programs, including autism/ neurodiversity access strategies, advocacy throughout the IBX system for neurodiversity inclusion and best practice approaches to supporting neurodivergent population health, including but not limited to autism care management program development.

  • Participates in identification, development and valuation of opportunities for holistic autism program development including access strategies, provider quality and partnership opportunities, outcomes measurement, and process improvement.
  • Develops autism provider performance measurement approaches and contributes to enterprise performance initiatives for behavioral health.
  • Coordinates with stakeholders to integrate behavioral health measurement in current and future quality improvement methodologies.
  • Supports provider relationship development to improve access and increase focus on clinical outcomes.
  • Partners with network and IBX stakeholders in support of operationalizing best-in-class Autism program.
  • Work directly with providers to foster positive relationships, including developing provider-facing communications to enhance provider satisfaction and understanding of IBX processes and expectations of providers.
  • Deliver training and education to support quality results and member experience.
  • Lead regular meetings to discuss processes, data/quality measurement, progress, improvement initiatives, quality campaigns, address care gaps.
  • Other activities in support of ASD care management operations including: access/capacity management system to support care navigation and connection to care, utilization and care management, identification and implementation of best practices in autism/neurodiversity programming designed to drive value.
  • Serves as point of contact and facilitates resolution of administrative issues for ABA providers including claims, credentialing, and other key services.
  • Collaborates with data and actuarial services to demonstrate the impact of interventions via medical cost offset.
  • Role includes an operational focus requiring project management competencies, data analyses, program goals, success measures, performance specifications, and output requirements to drive program development and execution progress.
  • Bachelor's degree; Master's degree in health-related fields a plus (e.g. MA, MPH).
  • 3-5 years' experience working with children and or adults with autism, experience providing case management or utilization management services for people with autism spectrum disorder.
  • Experience interacting with behavioral health providers, preferably ABA providers, in a professional, respectful manner that facilitates the treatment process.
  • Demonstrated knowledge and experience with quality autism care, autism care management programming and processes, behavioral health measures and quality outcomes.
  • Demonstrated experience with HEDIS measures required.
  • Knowledge of medical billing, claims processing systems, and health care information terminology preferred.
  • Strong verbal and written communication skills including but not limited to effective group presentations to professional staff and management.
  • Must be self-motivated, organized, and detail oriented, assume a collaborative role in ensuring that all objectives are met.
  • Must be able to work moderate complexity tasks independently.
  • Must have strong knowledge of Microsoft Office products (Outlook, Word, Excel, and PowerPoint).
  • Must have strong analytical, influencing, and problem-solving skills.
  • Must be a team player- builds team spirit and interdepartmental rapport, using effective problem-solving and motivational strategy.
  • Must have a strong commitment to total quality management and process improvement.
  • Acts as a resource for department, using focused professionalism and effective interactions.
  • Embrace the diversity of our workplace and show respect for colleagues internally and externally.
  • Hybrid work model allowing remote work 2 days a week.
  • Equal Opportunity Employer.
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