Manager of BH Provider Engagement

Reporting to the Director of Behavioral Health Network Strategy and Provider Engagement, the Manager of Behavioral Health Provider Engagement will be responsible for daily management, coaching and training of a team of Provider Relations Consultants to provide all activities including oversight of department operations, complex issue resolution, provider servicing ensuring all compliance and regulatory requirements are met for the Well Sense insourced behavioral health provider network.

Develops and implements network-wide education and training plan in NH and MA across Well Sense products. This position is integral to development of effective relationships with key behavioral health network contacts including but not limited to EOHHS, DHHS, DOI, and specialty providers. Directly responsible for the successful implementation of strategic provider relationships to meet department and network objectives. Includes working directly and cohesively with critical behavioral health trade organizations, ACO partners, and leadership to facilitate strategic provider activities.

• Full-time remote work
• Competitive salaries
• Excellent benefits

• Manages a team of behavioral health Provider Relations Consultants and acts as the relationship
  liaison between Well Sense and behavioral health providers, behavioral health trade organizations, EOHHS, DHHS, CMS and DOI leadership
• Ensures operational issues are managed through cross functional collaboration, avoiding
  escalation to internal or external stakeholders
• Coordinates and meets all regulatory reporting requirements
• Manages and coordinates the resources, responsibilities, processes, and workflows to ensure
  quality and timely account management support.
• Revise policies, processes, manuals, and documentation to maintain compliance with all regulatory requirements and clinical best practices
• Develop and report on Key Performance Indicators to ensure provider relationships are being appropriately managed.
• Analyze, synthesize, and interpret trends and data to identify opportunities for process improvement for both provider and internal teams
• Represent both provider and Plan voice in internal and external stakeholder meetings as well as in meetings related to medical cost management/vendor programs.
• Lead provider communication initiatives in collaboration with Communications, Marketing and Digital Strategy teams.
• Demonstrate knowledge of varying payment methodologies including but not limited to DRG, PCP Capitation, PCP sub-capitation, Fee-for-Service, Per Diem, Per cent of Charges
• Assists in the development and implementation of action plans related to provider satisfaction results and lead-time surveys.
• Gathers and analyzes competitive intelligence relative to provider network changes and trends in the marketplace.
• Ensures provider compliance with contractual, regulatory and NCQA requirements and standards.
• Ensure initiatives and tasks for provider orientations, trainings, education and service are timely, accurate and appropriate as defined by Plan and provider network is successfully integrated with Plan’s key internal stakeholders.
• Oversee a team of Provider Relations Consultants that will:
  • Manage, track and resolve day to day concerns and/or activities.
  • Support the timely and accurate completion of all reporting requirements.
  • Facilitate resolution of Plan operational issues impacting providers with input from subject matter experts
  • Manage the activities of complex work processes to achieve program goals
  • Meet regulatory and accreditation requirements.
  • Exercise independent judgment and communicate effectively with all cross functional teams
• Develops and maintains territory assignments for provider relations…