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DIRECTOR PROVIDER QUALITY in Boston, MA at Beacon Health Options

Date Posted: 1/18/2019

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a results-driven Director Provider Quality to join our team at our office in Boston, MA.  The Director Provider Quality will report to the AVP of Provider Quality, and will be primarily responsible for data and project management that support the initiatives and priorities of the Provider Quality Department.

Position Responsibilities:

Provider Quality Operations

  • Coordinate provider quality as well as “macro” utilization management activities and strategies across all Beacon health plans including but not limited to Inpatient Utilization Management, data systems including Cognos, Webe, profile data, outpatient utilization, SUD utilization, etc.
  • Coordinate, collaborate, problem solve and communicate on behalf of the department with other departments across Woburn and 1000 Washington including but not limited to credentialing, reporting, clinical, quality, claims, etc.
  • Manage and maintain data collection related to Provider Quality NCQA PQ work plan.
  • Plan and/or facilitate department meetings as assigned by AVP, examples may include RD/RNM meeting, Provider Quality Department trainings, Staff Trainings etc.
  • Provide leadership for the Provider Quality Department for FUH, IET and Community Tenure interventions.
  • Support Regional Provider Quality activities (technical assistance, site visits, UM follow-up, case rounding, select models).
  • Become an expert on datasets and reports relevant to Provider Quality, including the Provider Profiler, Value Based Payment reports, and Provider Select reports.
  • Create and provide regional provider data requests, including coordinating regional data requests outside of Provider Profiler, VBP, and Select Reports.

Training

  • Train all PQ staff as well as conduct interdepartmental trainings on how to effectively understand, leverage, and communicate the reports when engaging providers.
  • Conduct ongoing assessment of staff training needs. This includes planning as well as facilitating staff training and the development of training materials in consultation with AVP of provider quality.
  • Co-Facilitate the monthly Provider Quality all staff meeting
  • Provide Data trainings for staff and stakeholders including internal and external customers.

Data & Reporting

  • Serve as the liaison with reporting for regional reporting needs.
  • Contribute to the development of reports from various data sources to support provider quality initiatives and strategies.
  • Conduct COGNOS and data analysis as assigned to support provider quality initiatives (examples include preparation for rate meetings, data re: outlier analysis for various levels of care).
  • Facilitate data driven decision making throughout all of the above functions, such as through training department staff on available data systems, conducting data analysis, writing data analysis summaries, formulating recommendations, and incorporating data into workgroups and other functions.

Project Management

  • Provide project management, particularly on projects related to internal operations, and represent the department on internal workgroups and committees, also particularly related to internal operations. 
  • Function as a Performance Incentive Team Leader or member as assigned.

Other

  • Produce written materials related to any of the above functions, such as reports, project summaries, presentations, policies and procedures related to operations, etc.
  • Represent the department at external events, meetings, and workgroups as assigned.
  • Complete other responsibilities as assigned.

Position Requirements:

Education: Master’s degree in a behavioral health field

Licensure:  Appropriate licensure in a behavioral health field

Relevant Work Experience:   Minimum 5 years post graduate clinical experience; program and management experience preferred; managed care experience preferred; provider network management experience preferred;

Knowledge, Skills & Abilities:

  • Understanding of data and its use in network management preferred
  • Knowledge and experience with recovery principles and practices preferred.
  • Access to a vehicle and willingness to travel

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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