BH Performance Manager

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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

The Behavioral Health Performance Manager is responsible and accountable for behavioral health (BH) quality improvement programs, initiatives which comply with state contractual obligations, regulatory requirements, and accreditation standards. Has the ability to critically evaluate programs/performance outcomes and make recommendations while working collaboratively as appropriate with key stakeholders to include Health Plan leadership, organizational departments, BH providers and and ACO’s to meet the overall business objectives.

Our Investment In You

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

Key Functions/Responsibilities

• Serves as Quality Management subject matter expert to the BH program and executes new strategic BH quality initiatives designed to support corporate goals including NCQA accreditation.
• Consults to Quality department to ensure successful completion of quality improvement goals across the organization.
• Partners effectively with Quality department and other stakeholder departments to positively impact and influence identified corporate quality metrics, including but not limited to Withhold measures, PIPs and QIPs.
• As appropriate, serves as liaison with ACO Partners, strategic providers, local educational and clinical agencies to support partnership opportunities developed to enhance the BH services provided to the Plan members.
• As appropriate, shares overall network and specific provider performance metrics, as well as WellSense corporate quality priorities with providers and facilities planning (to include identification of potential process enhancements or interventions, and problem solves the removal of barriers) to meet identified goals.
• As directed by BH leaders, cooperates with Network department to prioritize providers and alternative payment methodologies or value based payment opportities.
• Implements strategic initiatives related to BH quality performance and HEDIS measures
• Tracks deliverables to NCQA BH related standards to support NCQA accreditation
• Works in collaboration with the accreditation team to ensure collected evidence meets NCQA standards.
• Works with MA and NH quality teams on identified HEDIS and withhold measures to review and understand requirements of the measures to inform interventions to impact the measure.
• Participates in the quality improvement committee to support in presenting related materials to support NCQA accreditation.
• Reviews and analyzes data related to quality measures, and clinical interventions to monitor outcomes.
• Attend meetings as indicated
• Work cross functionally with other departments and stakeholders.
• Provides project management oversight for inter-departmental BH care processes, including goal tracking, coordination of communication, problem solving and on-going follow-up
• Ensure integration across different departments, clinical programs, and BH vendor to evaluate current performance and outcomes.
• Regular and reliable attendance is an essential function of the position.
• Other functions as required to support departmental activities, to include overall day to day resolution of BH operational issues, as appropriate and assigned.
  
  

Supervision Exercised

• N/A
  
  

Supervision Received

• General Direction is received weekly by the Senior Manager of BH Program Performance
  
  

Qualifications

Education Required:

• Master’s Degree in Social Work, Behavioral Health, Public Health, MHA, or related field
  
  

Education Preferred

• Master’s Degree in Social Work, Behavioral Health, Public Health, MHA, or related field
  
  

Experience Required

• 5 + years behavioral health specific health care / managed care experience.
• Knowledge of and experience with clinical BH quality management and related business goals and practices within related areas.
• Experience with Medicaid populations
• Experience with NCQA and HEDIS/Withhold measures
  
  

Experience Preferred/Desirable

• Experience with Medicaid recipients and community services.
• Prior Behavioral Health Quality Management experience.
• Experience in implementing clinical interventions / measuring outcomes.
• Experience with data analysis
• Experience in project development and / or health policy.
• Lean Six Sigma training
  
  

Licensure, Certification Or Conditions Of Employment

• Licensed Mental Health Counselor or other applicable licensure for MA preferred
• Successful completion of pre-employment background check
  
  

Competencies, Skills, And Attributes

• Demonstrated ability in leading/ facilitating cross functionally across the organization
• Effective collaborative and proven process improvement skills.
• Demonstrated ability to successfully plan, organize and manage high impact projects.
• Demonstrated ability to work independently and manage multiple projects simultaneously.
• Strong analytical and problem solving skills.
• Strong oral and written communication skills; ability to interact within all levels of the organization.
• A strong working knowledge of Microsoft Office products.
• Demonstrated ability to successfully plan, organize and manage projects
• Detail oriented, excellent proof reading and editing skills.
  
  

Working Conditions And Physical Effort

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.
  
  

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

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