It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary
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 WellSense insourced behavioral health provider network. Develops and implements network-wide education and training plan in NH and MA across WellSense 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.
Our Investment In You
- Full-time remote work
- Competitive salaries
- Excellent benefits
Key Functions/Responsibilities
- Manages a team of behavioral health Provider Relations Consultants and acts as the relationship
liaison between WellSense 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 consultants
Supervision Exercised
Supervision Received
- General supervision is received weekly.
Qualifications
Education Required:
- College Degree (BA/BS) or related field is preferred but not required.
Education Preferred
- College Degree (BA/BS) or related field is preferred but not required.
Experience Required
- 3-5 years Healthcare/Provider Relations/Network Management experience required
Experience Preferred/Desirable
- In addition, 2 or more year’s supervisory experience strongly preferred.
Required Licensure, Certification Or Conditions Of Employment
- Successful completion of pre-employment background check
- Must have valid driver’s license and access to a car.
Competencies, Skills, And Attributes
- Understanding of the provider communities served
- Knowledge of federal Medicare, Medicaid regulations, guidelines and standards is a plus
- Proven demonstration of effective communication skills (verbal and written), and interpersonal skills to lead and direct the efforts of others, both internally and externally.
- Demonstrated ability to establish, build and maintain relationships with internal and external constituents
- Strong analytical, research and organizational skills
- Results oriented mindset and ability to mobilize multiple business areas to reach consensus and decision making
- Ability to influence others to achieve mutually beneficial outcomes and inspire trust
- Ability to think and react quickly to address questions and issues while interacting with the provider community
- Foster an atmosphere of collaboration and teamwork internally and externally
- Demonstrate initiative, judgment, discretion and ability to operate within politically sensitive framework
- Ability to be flexible, work independently and manage multiple tasks
- Demonstrated competence using Microsoft Office products especially Excel; familiarity with FACETS helpful
Working Conditions And Physical Effort
- Must be willing to travel to meet business needs required
- Ability to work in fast paced environment.
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
Required Skills
Required Experience
