Beacon Health Options
Job Category: Provider & Network – General
Req #: PROVI02731
Schedule: Full Time
Location: CO – Colorado Springs
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 Primary Care Provider Quality Managers (PCPQM to join our team remotely for our Colorado location. Primary Care Provider Quality Managers (PCPQM) are strategically oriented professionals who help lead the next generation of provider engagement, with a focus on leveraging the data available to primary care providers, helping to improve the value delivered to Beacon members. PCPQMs achieve this by building highly collaborative strategic partnerships and bringing an analytic mindset to discussions with providers. 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. PCPQMs drive provider performance improvement year-over-year through education and data. PCPQMs train practices on how to utilize data to:
- Improve care for members with chronic conditions
- Implement population health strategies
- Understand how their practice is performing on Key Performance Indicators and other health outcome measures
- Identify Members requiring Care Coordination
- Identify Members who require additional services
Data trends to be measured for improvement may 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
- Key Performance Indicators
- Other utilization patterns and trends
What does a typical day look like?
- Provide support to Primary Care Providers through face to face meetings, promoting integration of behavioral health and medical care, with a spectrum of activities-from increasing knowledge of behavioral health services and establishing linkages with behavioral health providers, to establishing integration of behavioral health services into primary care practices.
- Support Primary Care Providers in accessing care management services for Beacon Members.
- 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 an assigned set of Primary Care Providers. Meetings with providers are face to face, telephonic and via Web-Ex. General parameters for type and frequency of meetings are determined by the Regional Provider Quality Lead in collaboration with other Regional and National leaders. Type and frequency of meetings for specific providers are determined on a case by case basis.
- 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 assigned 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 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. Gather information on program structure, function efficacy and outcomes to share with Beacon colleagues. Work with those providers to implement the new concepts. Communicate and collaborate with regional leadership to support provider activities consistent with Beacon’s provider strategy and deliver progress to internal and external stakeholders. 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.
- Contribute 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.
- Provide consultation for clinically complex members.
- 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.
- Other duties and projects as assigned and specified by supervisor in line with Department and company needs.
- 60% primary local travel
What you Contribute?
Education: BA required. Advanced degree in healthcare field (nursing, behavioral health, public health highly preferred
License: Varies by state (RN, LCSW, LICSW, LMHC preferred
Knowledge, Skills & Abilities:
Knowledge of managed care, practice transformation, 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 a health care setting, either provider or payer, required, primary care preferred. Beacon anticipates the Provider Quality Manager will spend time each week in four main 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)
- Practice Transformation
- Practice Transformation Coach
- Practice Transformation Specialist
- Lean Six Sigma
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
- Tuition reimbursement so you can keep reaching your fullest potential
If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!….. click apply for full job details
Provider Quality Manager – Colorado Springs, Colorado