Anticipated End Date:

2025-03-31

Position Title:

Behavioral Health Provider Quality Manager

Job Description:

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 Carelon BH members. Drives BH provider performance improvement year over year through education and data. This role is responsible for a local market.

Location: Candidates must reside and be licensed in the state of Florida.

How you will make an impact:

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 Teams.

Acts as a liaison between strategic providers and Carelon BH 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 Carelon BH.

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. Perform medical record and case management file reviews for enrollees who are high utilizers of CSU and inpatient psychiatric hospital services, Baker Act receiving facilities, and/or CSUs.

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 Carelon BH 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.

Minimum Requirements:

Requires MA/MS or above in Behavioral Health field and 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.

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.

Preferred Skills, Capabilities, and Experiences:

Managed care experience preferred.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

MED > Licensed/Certified Behavioral Health Role

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.