Director, Care Management
Community Memorial Healthcare
Quality Manager – Behavioral Health Provider
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Redding • California • 🇺🇸 United States
Visit company websiteSalary
💰 $75,200 - $112,800 per year
Job Level
SeniorLead
About the role
- Establishes relationships and engages with behavioral health (BH) providers to ensure measurable improvements in clinical and quality outcomes for members.
- Drives BH provider performance improvement year over year through education and data.
- Builds relationships with internal clinical and quality departments to ensure high-quality care and achievement of company HEDIS performance.
- Implements strategies that meet clinical, quality, and network improvement goals.
- Builds 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.
- Acts as a liaison between strategic providers and Carelon clinical, quality, provider strategy, operations, and claims to ensure interdepartmental collaboration.
- Supports regional and corporate initiatives regarding Carelon Select Provider (CSP) program, clinical innovation, and thought leadership.
- Creates and maintains linkages between providers and community-based services 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 outcomes.
- Analyzes provider reports on cost, utilization, and outcomes; presents data to providers and highlights trends; identifies outliers and improvement opportunities.
- Identifies high-performing and innovative providers for potential programmatic incentives or new payment models.
- Participates in design, implementation, launch, and measurement of pilot programs and evaluates efficacy and outcomes.
- Provides consultation to providers for clinically complex members as applicable and surfaces clinical/quality issues to regional teams.
- Conducts quarterly physician record reviews with network providers across all service levels and assists with provider orientations and training events.
- Attends County BH provider meetings in person or via telephone/Web-Ex as applicable.
- Required to travel to field locations in Northern California and work virtually as needed.
Requirements
- Candidates must posses a licensure for the state of California.
- Current, valid, independent, and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable state laws) is required.
- MA/MS or above in Behavioral Health field required.
- Minimum of 10 years of progressively responsible professional experience in healthcare.
- 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.
- Ideal candidate will reside in or near Shasta or Humboldt counties; candidates residing in Shasta, Humboldt, Solano and Sonoma HIGHLY preferred.
- Ability and willingness to travel to the field in Northern California as needed.
- Managed care experience preferred.
- Behavioral Health experience preferred.
- Ability to work Pacific Standard Time schedule.
- For certain patient/member-facing roles: COVID-19 and Influenza vaccination required unless acceptable explanation is provided.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase and 401(k) contribution
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical, dental, and vision insurance
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
- Flexible work arrangements (work virtually and in the field; Hybrid Workforce Strategy)
- Professional and career development opportunities
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisclinical quality improvementprovider performance improvementprogram designpilot program implementationconsultation for complex membersrecord reviewstraining and educationcontractingcredentialing
Soft skills
relationship buildinginterdepartmental collaborationcommunicationproblem-solvingstrategic thinkingleadershipteamworkadaptabilitynegotiationstakeholder engagement
Certifications
RNLCSWLMFTLMHCLPCLicensed Psychologist
