Manager, Provider Account Management - Behavioral Health

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

This leader is responsible for cultivating, maintaining and strengthening relationships with our network of behavioral health providers and trade associations, in all geographic areas where we do business. Additionally, this person helps shapes strategy and policies relevant to our behavioral health provider network. While working across the business, this individual will create positive working relationships with providers, resolving provider inquiries and navigating the nuances of our markets, including regulatory requirements. This position requires a proactive self-starter with independent initiative and strong skills to strategically lead the behavioral health provider account management team.

The Provider Account Management Manager will manage a staff who are liaisons internally between departments within Point32Health and externally with providers. Working in a heavily matrixed environment, the Manager of Provider Account Management (or Manager of Provider Relations) must possess flexibility, management skills, leadership skills, ability to think and act strategically, independent initiative and excellent communications skills.

Key Responsibilities/Duties – what you will be doing

DUTIES/RESPONSIBILITIES – what you will be doing:

• Strategically manage and successfully lead Enterprise Behavioral Health Provider Account Management Team to ensure operational issues are well managed and do not get escalated and/or interfere with negotiations with our Contracting team.
• Manage and coordinate the resources, responsibilities, processes, and workflows to ensure quality and timely account management support. Revise policies, processes, manuals, and documentation to maintain compliance and clinical best practices.
• Monitor the overall progress of team initiatives and provide status updates to leadership, managers and representatives of partner departments such as Behavioral Health, Network Contracting, Medical Policy, Servicing, Product Strategy, Claims, Legal, Pharmacy, and Care Management.
• Own and drive strategic and operational priorities for the provider, leading and bringing in support from internal corporate departments as necessary.
• Strategically lead successful implementation of new accounts/partnerships by identifying most appropriate/suitable provider account management needs and ensuring that the provider needs are met.
• Develop and report on KPIs, relationship metrics and measurements to ensure provider relationship as being appropriately managed. Analyze, synthesize, and interpret trends and data to identify opportunities for process improvement for both client and operations team.
• Represent the provider voice and Point32Health voice in stakeholder meetings as well as in meetings related to medical cost management/vendor programs.
• and collaborate cross-functionally to ensure that provider needs are met and that escalated issues are resolved.
• Lead key provider and Point32Health internal meetings required to execute on strategies, including the development of agenda, materials, preparation and facilitation.
• Other duties and projects as assigned.

Qualifications – what you need to perform the job

QUALIFICATIONS – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

• Bachelor’s Degree in business or healthcare management; Master’s Degree preferred.
• Knowledge of health care insurance industry is a must (experience in behavioral health is preferred).

EXPERIENCE (minimum years required):

• Minimum 10+ years of experience in a health care environment with a proven track record of establishing, building, and managing accounts.
• Management e