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　　BH Provider Qual Mgr - CA

　　Job Family: Behavioral Health

　　Type: Full time

　　Date Posted:Jan 16, 2024

　　Anticipated End Date:Feb 16, 2024

　　Reference: JR101010

　　Location:

　　CA, CERRITOS

　　California

　　Description

　　Carelon Behavioral Health, Inc. is enthusiastically supporting the launch of the Statewide School-Based Fee Schedule project by the Department of Health Care Services (DHCS) as the dedicated Third-Party Administrator. Our goal? To improve the mental health services offered to California's young students via this pivotal initiative.

　　We're expanding our team and eager to connect with professionals experienced in healthcare administration, network management, provider credentialing, data analysis, and claims processing. You'll play an essential role in managing claims payments and remittances, overseeing our provider network, credentialing providers, undertaking data exchanges, and maintaining quality oversight.

　　With this project, we're aligning our goals with Governor Newsom's Kids’ Mental Health and the Children and Youth Behavioral Health Initiative (CYBHI). We're working closely with DHCS, the Department of Managed Health Care (DMHC), and the California Department of Insurance (CDI) to implement a multi-payer fee schedule, ensuring fair reimbursement for school-linked providers offering designated outpatient mental health and substance use disorder services.

　　Behavioral Health Provider Quality Manager - CALIFORNIA

　　Candidates must have a Clinical licensure in the state of CA.

　　Location: This position will work a Hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles from one of our Elevance Health corporate offices. This position will travel to worksite and other locations as necessary.

　　*Seeking candidates that reside in either: Northern California or Southern California.

　　Work Shift: Monday thru Friday, 5 days a week during Pacific Standard Time business hours.

　　The BH Provider Quality Mgr 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 Behavioral Health members. Drives behavioral health provider performance improvement year over year through education and data. This role is responsible for the California market.

　　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 virtually.

　　Acts as a liaison between strategic providers and Carelon Behavioral Health 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 Behavioral Health.

　　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.

　　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 Behavioral Health 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.

　　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 either a RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable by state laws) in the state of California is required .

　　Preferred Skills, Capabilities and Experiences:

　　Experience working in the behavioral health field.

　　Experience working with providers.

　　Managed care experience.

　　For candidates working in person or remotely in the below locations, the salary* range for this specific position is $76,560 to $125,280.

　　Locations: California

　　In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

　　The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.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. 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 [email protected] for assistance.

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