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PROVIDER QUALITY MGR - MPP (Valid California State Clinical License Required -MSN, MSW, LMFT)
Beacon Health Options • US-Nationwide
Posted 29 days ago
ABOUT THE POSITION
We are currently seeking a dynamic Provider Quality Manager (PQM) to join our team at our office in Northern CA. The Provider Quality Manager (PQM) is responsible to help lead the next generation of provider engagement, with a focus on leveraging the data available to providers, helping to improve the value delivered to Beacon members. PQMs achieve this by building highly collaborative strategic partnerships and bringing an analytic mindset to discussions with providers. PQMs drive provider performance improvement year-over-year through education and data.
PQM performance is assessed not only on the ability to establish relationships and engage providers, but by evidence of measurable improvements in clinical and quality outcomes for Beacon Members. Data trends to be measured for improvement include (but are not limited to):
• FUH, IET and other HEDIS outcomes • Cost metrics • Trends in length of stay • Readmission Rates • Community Tenure • Access to medically necessary care • Successful transitions of care • Quality outcomes • Other utilization patterns and trends
Remote position within Northern, CA or Bay Area. Must be willing to travel 60% locally within CA region.
- Implement regionally based strategies that meet clinical, quality, and network improvement goals through positive working relationships with providers, state agencies, advocacy groups and other market stakeholders.
- Interface with a strategic subset of Beacon’s network of behavioral health providers. Meetings with providers are face to face, telephonic and via Web-Ex.
- Liaison for Beacon clinical, quality, Provider Strategy, and network departments to ensure interdepartmental collaboration and coordination of goals and priorities.
- Support 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.
- Ensure, and create as necessary and as applicable depending on the regional market, 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.
- Partner with network providers and Beacon stakeholders to operationalize innovative programs and strategies to improve clinical and quality outcomes.
- Analyze strategic provider reports pertaining to cost, utilization, and outcomes, and prepare this data to share with providers. Lead analysis of data sets that identify data outliers and opportunities for improvement for individual providers. Present data strategically, detailing patterns and trends in provider performance over time.
- Share data to help educate strategic providers about Beacon’s mission and vision, with a focus on driving high levels of value for Beacon members and delivering on performance on behalf of Beacon’s clients.
- Identify high-performing and innovative providers who may be interested in new programmatic or payment models. Gather information on program structure, function efficacy and outcomes to share with Beacon colleagues. Work with those providers to implement the new concepts.
- Collaborate 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. Help identify opportunities with regional and corporate leadership for expansion and development of innovative pilot programs, to include program development, implementation, launch, and efficacy and outcomes measurements. Provider innovations should reflect Beacon’s thought leadership.
- Other duties as assigned
Beacon anticipates the Provider Quality Manager will spend time each week in the following ways:
Strategic Provider outreach and meetings (2 – 3 days/week)
Analyze provider data to determine utilization and outcomes outliers, including root cause analysis for outliers and utilization patterns (1 day/week)
Developing strategy for specific provider engagement activities to be executed (1 day/week)
PowerPoint report generation to prepare for on-site provider outreach meetings (1/2 - 1 day/week)
Support linkage for Provider-specific problem resolution and navigation of Beacon by connecting providers to the appropriate Beacon staff (1/2- 1 day/week)
Education: Master’s Degree in Behavioral Health
Licensure: Independent licensure is required. Valid California State Clinical License (MSN, MSW, LMFT, PhD or PsyD)
Relevant Work Experience:
Minimum 5-7 years of experience in behavioral health setting, either provider or payer, required.
Knowledge of managed care, analytics, performance improvement and clinical skill preferred
Strong execution and follow-up skills, analytic skills, organization, and ability to multi-task.
Knowledge, Skills & Abilities:
Good customer relations skills
Must possess high-level written and verbal skills
Ability to recognize and/or anticipate the needs of customers and respond accordingly
Ability to multi-task
Ability to learn, master, and incorporate use of variety of clinical and administrative automated systems and software into daily work.
Must be self-directed and resourceful.
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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