Behavioral Health Provider Quality Manager – Field
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Pittsburgh • Pennsylvania • United States
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About the role
- This is a field role covering northwestern and southwestern Pennsylvania
- When you are not in the field, you will work virtually from your home
- Travel is required throughout your assigned area(s)
- 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
- 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
Requirements
- Requires MA/MS in a Behavioral Health field
- Minimum of 10 years of professional experience in healthcare
- 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 is required
- Previously quality experience is very helpful
- Experience analyzing and interpreting data is preferred
- Proficiency in Microsoft applications, especially Excel, is strongly preferred
- Managed care experience preferred
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisclinical outcomes improvementquality improvementprovider report analysismedical record reviewprogram developmentbehavioral health expertisealternative payment modelsvalue based paymentclinical innovation
Soft Skills
relationship buildinginterdepartmental collaborationcommunicationconsultationproblem-solvingleadershipstrategic thinkingorganizational skillspresentation skillsteam collaboration
Certifications
RNLCSWLMFTLMHCLPCLicensed Psychologist