Behavioral Health Provider Strategy Coord

Job Summary:

This position is responsible for implementing various initiatives that cross department lines in support of Horizon Behavioral Health’s (HBH) strategic goals and will interface with all levels of management to ensure that all objectives are met and initiatives are implemented. This position is also responsible for supporting accreditation, state and federal guidelines as well as divisional goal compliance.

Responsibilities:

• Research, coordinate and oversee development and implementation of special projects, studies and reports to satisfy information demands of management or various accreditation and regulatory requirements.

• Ensure behavioral health network compliance and consistency by identifying and correcting deficiencies relating to network compliance and/or network consistency.

• Support and implement quality improvement, accreditation, regulatory and/or compliance activities, i.e. NCQA, CMS, including the coordination and preparation of reports of findings and process measure, annual behavioral health network related accreditation reports to support ongoing accreditation for all lines of business. 

• Conducts site visit and other meetings with behavioral health ancillary providers and professional practices that have identified quality related trends.

• Support the implementation of key strategic initiatives and enterprise system enhancements including business requirement gathering, testing review, and implementation planning activities with HBH.

• Provide wraparound support to Behavioral Health leadership, program leadership, Network Exec II and/or BH Physician Contracting specialist in the onboarding of new special arrangement groups, including credentialing application collection, coordination with PDM team, and provider orientation/onboarding post contract execution.

• Develop, implement and drive Action Plans to improve provider performance, CAHPS and HEDIS scores in collaboration with BH Network Management team and HBH Quality Management team.

• Develop, implement and monitor policies, procedures, workflows and process improvements related to the HBH network and special programs. .

• Develop, coordinate and disseminate behavioral health professional and ancillary facility provider communications.

• Develop and coordinate education documents for internal and external audiences.

• Represents BH department at workgroup meetings and facilitates cross-functional teams to implement various strategic initiatives.

• Create and develop materials for seminars; this includes interacting with leadership of other divisions and contracting and negotiating with outside organizations and vendors.

• Develop and drive Action Plans to improve Office Manager Satisfaction Survey results and compliance with appointment availability standards.

• Develop responses to RFIs and RFPs regarding Horizon's behavioral health network, contracting standards and processes and ensure timely and accurate responses to the Proposal Department.

• Support recruitment, retention and provider outreach initiatives.

• Conduct file audits to ensure compliance with regulatory and contractual requirements.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree preferred or relevant experience in lieu of degree.

• Requires 3-5 years’ healthcare experience, preferably with provider or client focus/interaction.

• Prefers behavioral health related experience in the healthcare/insurance industry.

Knowledge:

• Require solid understanding of managed care principles.

• Require knowledge of healthcare industry.

• Prefer knowledge of behavioral health contracting/network relations.

• Prefer knowledge of NCQA accreditation standards and State and Federal healthcare regulations.

• Prefer knowledge of major competitors.

Salary Range:

$76,800 - $102,795

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known t