Behavioral Health Provider Quality Manager
We are currently hiring for the
Maryland Behavioral Health Administrative Services Project!
ATHENA Consulting is an award-winning staffing firm serving state and local governments. Our mission is to make lives better! We make our Clients’ Lives Easier by engaging and supporting our clients and partnering with them to be the most knowledgeable staffing partner. We make our Employees’ Lives Better by identifying and cultivating their talents and matching these talents with our customers’ needs. ATHENA places a high value on customer service, accountability and getting the job done.
POSITION SUMMARY:
This FULL-TIME position ranges from $35.00-$37.00 per hour depending on experience and is located in Hanover, Maryland. The Behavioral Health 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 Beacon members. Drives BH provider performance improvement year over year through education and data, and related duties as assigned.
This role is currently Hybrid and based in MD.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
- This role is responsible for a local market.
- 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 Web-Ex.
- Acts as a liaison between strategic 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 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 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, 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 provider orientations and provider training events in the region, when applicable.
- Participate in developing department goals, objectives, and systems
- Participate in staff meetings and attend other meetings and seminars as assigned.
- Recommend new approaches, policies, and procedures, to continually improve efficiency of the department and services performed.
- Efficiently performs duties as assigned and works as a team within division and company.
- Perform other related duties as assigned.
Education and Experience Requirements:
- Requires a Master of Arts or Master of Science or above in Behavioral Health field
- 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.
- Managed care experience preferred.
- 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.
- Travels to worksites and other locations as necessary.
Physical Requirements:
- Possible prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift and move up to 25 pounds at times.
- Standard hours of work Monday through Friday, 8:00 am – 5:00 pm.
- Travel may be required up to 35% of the time.
Successful ATHENA employees will display the following characteristics:
- You strive to be the best in your field currently and in the future.
- You like to make your employer look good.
- You find solutions, where others only see problems.
- You are proactive, you make and meet commitments, and you perform your duties exceedingly well.
- You are aware of the employer’s needs at all times and are well-versed in what you personally and ATHENA can offer them as a whole.
- You have the ability to work with diverse, integrated, deliverable-driven teams to accomplish the larger mission.
The benefits of working for ATHENA include a full Benefit package:
- Support from a team of professionals committed to making your life better.
- 19 days of PTO.
- 12 paid holidays, 13 paid holidays during election years.
- Merit / COLA increases.
- Flex time allowed, during the same week.
- Medical, dental and vision insurance.
- Medical and dependent flexible spending account.
- Pet insurance.
- Mass transportation benefit for the Maryland and Washington, D.C. area.
- 401k with a generous employer match.
- Easy to use employee self-serve HR portal.
The statements in this Job Posting are intended to describe the general nature and minimum level of work required. The content should not be construed as a complete list of all duties, responsibilities, and skills required to meet the criteria for this position. Upon request, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Application for employment is not intended to and does not create a contract or offer of employment and if hired, employment with the company is on an at-will basis and could be terminated at the will of either party.
ATHENA Consulting LLC does not discriminate in hiring based on federally protected classifications to include but not limited to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, marital status or other characteristics protected by law. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.
