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Elevance Health · 20 hours ago

Behavioral Health Community Partnership Manager - Northern California

Sacramento, CA

Full-time

Hybrid

Senior Level, Lead/Staff

$75K/yr - $124K/yr

10+ years exp

Elevance Health is a health company dedicated to improving lives and communities. They are seeking a Behavioral Health Community Partnership Manager to lead provider engagement and improve clinical and quality outcomes for Carelon members in Northern California. The role involves establishing relationships with providers, analyzing performance data, and implementing improvement strategies.

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Responsibilities

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

Build positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders

Meets routinely with strategic providers face to face, telephonically, and via Web-Ex to support provider training on Carelon processes, contracting / credentialing and linkages for issue resolution, helping to improve provider experience and overall satisfaction with Carelon

Acts as a liaison between strategic providers and Carelon clinical, quality, provider strategy, operations, and claims, to ensure interdepartmental collaboration and coordination of goals and priorities

Supports regional and corporate initiatives regarding Carelon Select Provider (CSP) program, clinical innovation, and thought leadership transforming provider relationships from transactional interactions to collaboration

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 stakeholders to operationalize innovative programs and online resources 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 incentives or payment models

Participates in the identification of opportunities for expansion and development of innovative pilot programs, implementation, launch, and efficacy and outcomes measurements

Contributes to the identification of high-quality program ideas/designs into the local market to drive high levels of value

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 quarterly physician record reviews or as needed with network providers across all service levels

Assists with provider orientations and provider training events in the region, when applicable

Attends all accessible County BH provider meetings either in person or via telephone or Web-ex

Qualification

Behavioral Health licensureProvider engagementData analysisManaged care experienceRelationship buildingCommunication skillsTeam collaboration

Required

Candidates must possess a licensure for the state of California

Requires MA/MS or above in Behavioral Health field and a 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 RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable by state laws) is required