Beacon Health Options
Job Category: Provider & Network – General
Req #: MGRPR02862
Schedule: Full Time
Location: CA – San Francisco
We Help People Live their Lives to the Fullest Potential!
For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a ‘world-class’ candidate experience from the moment you click ‘Apply’! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.
Do you have a passion for helping others? If so, we are looking for you!
Beacon is currently seeking a Manager Provider Quality to join our team remote in Northern California. Provider Quality Managers (PQM) are strategically oriented professionals who 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
Building relationships with internal Beacon teams will be necessary to be successful in this role, in particular coordinating closely with clinical and quality departments, to ensure high quality care to members, and achievement of company HEDIS performance, as applicable to the regional market.
What does a typical day look like?
- Strategic Provider outreach and meetings (3-4 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)
- 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. General parameters for type and frequency of meetings are determined by the Regional Provider Quality Lead in collaboration with other Regional and National leaders.
- 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.
- Liaison between strategic providers and Beacon Operations, Claims and Provider Relations departments to support linkages for issue resolution, helping to improve provider experience and overall satisfaction with Beacon.
- 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. Highlight key areas of focus, including interpretation of provider utilization data that show patterns. Ensure that data is kept meaningful to providers.
- 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
- to the identification of best practices across the entire group of PQMs nationally and integrate high-quality program ideas/designs into the local market to drive high levels of value.
- Surface clinical and quality issues to Beacon’s regional clinical and quality teams and participate in helping to address concerns.
- Work with Beacon clinical teams to be knowledgeable regarding Beacon UM and care management programs and services, to be able to answer or appropriately triage provider questions.
- Conduct medical record reviews annually or as needed with network providers across all service levels.
- Assist with provider orientations and provider training events in the region; trainings and orientations will be led by Beacon’s network operations team.
- Closely collaborate with Beacon’s network operations team to ensure a fluid bi-directional sharing of information.
- Reliable transportation and ability to travel within local market on a regular basis is required.
- 70% travel
What you Contribute?
Education: Master’s or Doctoral Degree in Behavioral Health required
Licenses: Current driver’s license. Clinical license LCSW, LMHC, PhD, LMFT required
Knowledge, Skills & Abilities: 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 are key. 5-7 years of experience in behavioral health setting, either provider or payer, required..
What Makes Us Different?
- Here, it’s not just a job – it’s an opportunity to change lives.
- Our employees are learners, innovators and original thinkers.
- Our mission and values guide the way we treat our members, providers and each other.
What We Have to Offer:
- Healthcare benefits available starting day 1!
- Health & wellbeing incentives, such as gym membership reimbursement
- 401K with company match to help reach your future financial goals
- Generous PTO, because we know life happens outside of work
If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!
Click below on “Apply for this Position” to create a profile and apply for the position
Beacon Health Options company, is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
At Beacon Health Options, our candidate’s data privacy is a top priority. Our recruiting team conducts all communications using official company email Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from #GD
Mgr Provider Quality – San Francisco, California