Elevance Health
Behavioral Health Provider Quality Manager
Elevance Health, Sonoma, California, United States, 95476
Overview
Position Title: Behavioral Health Provider Quality Manager Anticipated End Date: 2025-11-17 Candidates must possess a licensure for the state of California. The ideal candidate will reside in or near Redding, Shasta, Humboldt, Sonoma or Eureka counties. This role enables associates to work virtually as well as in the field for client visits, providing flexibility and autonomy to support productivity and work-life balance. Per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law. The position may require travel to the field in Northern California. Schedule: Pacific Standard Time. A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers clinical mental health and substance use disorder management, an employee assistance program, work/life support, autism and depression programs, and analytics to improve care delivery. Location: California. Elevance Health offers a comprehensive benefits package; salary is described below with factors related to location, experience, and education. Elevance Health is an Equal Employment Opportunity employer. Responsibilities
Establishes relationships with behavioral health (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 and achieve HEDIS performance; implements strategies to meet clinical, quality, and network goals. Fosters positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders. Meets with strategic providers in person, by phone, or via Web-Ex to support provider training on Carelon processes, contracting/credentialing, and issue resolution; aims to improve provider experience and satisfaction. Acts as a liaison between strategic providers and Carelon clinical, quality, provider strategy, operations, and claims to ensure interdepartmental collaboration and alignment of goals. Supports regional and corporate initiatives regarding the Carelon Select Provider (CSP) program, clinical innovation, and thought leadership to transform provider relationships from transactional to collaborative partnerships. Creates and maintains linkages between providers at all levels of care 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 clinical and quality outcomes. Analyzes provider reports on cost, utilization, and outcomes; presents data to providers and highlights trends. Identifies data outliers and opportunities for improvement for individual providers. Identifies high-performing and innovative providers for potential incentives or new payment models. Participates in identifying opportunities for expansion and development of innovative pilots, implementation, launch, and efficacy and outcomes measurements. Contributes to high-quality program ideas/designs for the local market to drive value. Provides consultation to providers for clinically complex members as applicable. Surfaces clinical and quality issues to regional clinical and quality teams and assists in addressing concerns. Conducts quarterly physician record reviews or as needed with network providers across service levels. Assists with provider orientations and provider training events in the region, when applicable. Attends all accessible County BH provider meetings in person or via telephone/WebEx. Minimum Requirements
Requires MA/MS or above in Behavioral Health and a minimum of 10 years of progressively responsible professional healthcare experience, including at least 5 years in a behavioral health setting (provider or payer) or an equivalent background. Current, valid, independent, and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by state laws) is required. Preferred Skills, Capabilities, And Experiences
Candidates who reside in Shasta, Humboldt, Solano and Sonoma counties are highly preferred. Behavioral Health experience preferred. Travel to worksite and other locations as necessary preferred. Managed care experience preferred. Compensation and Benefits
For candidates working in person or virtually in the listed location(s), the salary range for this position is $75,200 - $112,800. Location: California. Benefits include a comprehensive package, incentive programs, 401(k) matching, stock purchase plan, and other programs subject to eligibility requirements. The salary range is approximate and may be adjusted based on factors such as geography, experience, education, and market conditions. Compensation details are governed by applicable policies and plans.
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Position Title: Behavioral Health Provider Quality Manager Anticipated End Date: 2025-11-17 Candidates must possess a licensure for the state of California. The ideal candidate will reside in or near Redding, Shasta, Humboldt, Sonoma or Eureka counties. This role enables associates to work virtually as well as in the field for client visits, providing flexibility and autonomy to support productivity and work-life balance. Per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law. The position may require travel to the field in Northern California. Schedule: Pacific Standard Time. A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers clinical mental health and substance use disorder management, an employee assistance program, work/life support, autism and depression programs, and analytics to improve care delivery. Location: California. Elevance Health offers a comprehensive benefits package; salary is described below with factors related to location, experience, and education. Elevance Health is an Equal Employment Opportunity employer. Responsibilities
Establishes relationships with behavioral health (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 and achieve HEDIS performance; implements strategies to meet clinical, quality, and network goals. Fosters positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders. Meets with strategic providers in person, by phone, or via Web-Ex to support provider training on Carelon processes, contracting/credentialing, and issue resolution; aims to improve provider experience and satisfaction. Acts as a liaison between strategic providers and Carelon clinical, quality, provider strategy, operations, and claims to ensure interdepartmental collaboration and alignment of goals. Supports regional and corporate initiatives regarding the Carelon Select Provider (CSP) program, clinical innovation, and thought leadership to transform provider relationships from transactional to collaborative partnerships. Creates and maintains linkages between providers at all levels of care 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 clinical and quality outcomes. Analyzes provider reports on cost, utilization, and outcomes; presents data to providers and highlights trends. Identifies data outliers and opportunities for improvement for individual providers. Identifies high-performing and innovative providers for potential incentives or new payment models. Participates in identifying opportunities for expansion and development of innovative pilots, implementation, launch, and efficacy and outcomes measurements. Contributes to high-quality program ideas/designs for the local market to drive value. Provides consultation to providers for clinically complex members as applicable. Surfaces clinical and quality issues to regional clinical and quality teams and assists in addressing concerns. Conducts quarterly physician record reviews or as needed with network providers across service levels. Assists with provider orientations and provider training events in the region, when applicable. Attends all accessible County BH provider meetings in person or via telephone/WebEx. Minimum Requirements
Requires MA/MS or above in Behavioral Health and a minimum of 10 years of progressively responsible professional healthcare experience, including at least 5 years in a behavioral health setting (provider or payer) or an equivalent background. Current, valid, independent, and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by state laws) is required. Preferred Skills, Capabilities, And Experiences
Candidates who reside in Shasta, Humboldt, Solano and Sonoma counties are highly preferred. Behavioral Health experience preferred. Travel to worksite and other locations as necessary preferred. Managed care experience preferred. Compensation and Benefits
For candidates working in person or virtually in the listed location(s), the salary range for this position is $75,200 - $112,800. Location: California. Benefits include a comprehensive package, incentive programs, 401(k) matching, stock purchase plan, and other programs subject to eligibility requirements. The salary range is approximate and may be adjusted based on factors such as geography, experience, education, and market conditions. Compensation details are governed by applicable policies and plans.
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