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PROVIDER QUALITY MANAGER in Springfield, MA at Beacon Health Options

Date Posted: 1/25/2019

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic PROVIDER QUALITY MANAGER to join our team at our office in SPRINGFIELD, MA and support the Western Region.  The Provider Quality Manager will report to the Regional Director of Provider Quality and be responsible for building highly collaborative relationships with providers and driving provider performance improvement year-over-year through education and data. They will implement regionally based strategies to meet statewide clinical, quality, and network improvement goals through positive working relationships with providers and state agencies and work collaboratively with members of the IRT to insure coordinated network management activity, consistent with statewide mandates.

Position Responsibilities:

  • Develop and maintain relationships with key clinical and administrative leadership within the provider network
  • Create linkages between IP, OP, ACOs, CHCPs and/or other community based services for improved transition of care planning
  • Partner with network providers and Beacon stakeholders to operationalize innovative programs or strategies to improve clinical and quality outcomes
  • Ongoing meetings to review aggregate data demonstrating clinical and quality performance
  • Utilize aggregate data to demonstrate performance
  • Conduct macro level utilization management via identifying trends
    • FUH/IET outcomes
    • Readmission Rates
    • Cost metrics
  • Collaborate with network providers across all service levels
    • Inpatient MH - Monthly, bi-monthly, or Quarterly as determined by UM tier
    • Review UM tier status with potential for movement based on ALOS trends
      • IP SUD - Quarterly
      • Diversionary – Quarterly
      • Outpatient - Quarterly
      • ESP – Quarterly
  • Develop individualized strategic plans to improve provider performance towards established regional clinical and quality work goals
    • HEDIS 90th percentile
    • Increase IET rates
    • ALOS targets based on providers’ historical performance
    • Community tenure
  • Reduce readmission rates
  • Create linkages between IP, OP, ACOs, BHCPs and/or other community-based services for improved transition of care planning.
  • Facility-based care collaboration with targeted providers
    • Weekly (or as appropriate) on-site meetings
      • Rounding on Beacon members currently at facility
        • Review transition of care planning, including barriers to improve rate of scheduled 7-day follow-up appointments post discharge
        • Consultation for clinically complex members
        • Observation of clinical and quality practices to identify opportunities for improvement
      • Utilize member-level data to provide continuous feedback regarding post-discharge transition of care outcomes
        • FUH/IET outcomes
        • Readmissions to inpatient levels of care
    • Advocacy with Acute Services Providers (telephonically and while at other Facility-based activities) relative to access to care, i.e. admissions referrals from ESPs, and consistent with the EOHHS/DMH Expedited Admissions Policy
  • Analysis of proposals for additions to the Beacon network to determine need based on current network utilization and geo-access review
  • Present analysis at weekly Quality Operations meetings
  • New provider/facility seeking entry to the Beacon network
  • Existing provider adding new sites/services to the Beacon network
  • Partner with network providers and Beacon stakeholders to operationalize innovative programs or strategies to improve clinical and quality outcomes (i.e. VBP models)
  • Conduct medical record reviews annually or as needed, with network providers across all service levels
  • Serve as a liaison with internal Beacon departments to resolve provider issues

Position Requirements:

Education: Master’s degree in Behavioral Health required

License(s):  Independently behavioral/mental health license is required

Relevant Work Experience:  Knowledge of managed care, analytics, performance improvement and clinical skill preferred. Preferably five years managed behavioral healthcare or related experience.

Knowledge, Skills & Abilities:

  • A working knowledge of account management, customer relations and business management are essential
  • Strong execution and follow-up skills, analytic skills, organization and ability to multi-task are key.
  • Knowledge of MS Office – Word, Excel, PowerPoint, MS Project & COGNOS
  • Interpersonal communication skills and includes both verbal and written.
  • Collaboration and team-oriented work philosophy.

TO APPLY

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

Beacon Health Options company is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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