Provider Quality Manager

Medical devices, Pharmaceuticals, Health, Social work
Not specified
Contract type:
Full time
Salary description:
Specialist areas:
Quality assurance (main), Audit/assessment, Consultancy, Health and safety, Operational improvement, Project management, Risk management
Start Date:
Beacon Health Options
Job Ref:

Beacon Health Options

Job Category: Provider & Network - General
Req #: PROVI01318
Schedule: Full Time
Location: MA - Bridgewater

Beacon is currently seeking a P r ovider Quality Manager to join our team at our Bridgewater, MA office. This position builds highly collaborative relationships with providers and drives provider performance improvement year-over-year through education and data. Implements regionally based strategies to meet statewide clinical, quality, and network improvement goals through positive working relationships with providers and state agencies. Works collaboratively with members of the IRT to insure coordinated network management activity, consistent with statewide mandates. Within the Region 1 Provider Quality Department, this position reports to the Regional Directors of Provider Quality.

What does a typical day look like?

* Develop and maintain relationships with key clinical and administrative leadership within the provider network
* Create linkages between IP, OP, ACOs, CHCPs and/or other community based services for improved transition of care planning
* Partner with network providers and Beacon stakeholders to operationalize innovative programs or strategies to improve clinical and quality outcomes
* Ongoing meetings to review aggregate data demonstrating clinical and quality performance
* Utilize aggregate data to demonstrate performance
* Conduct macro level utilization management via identifying trends
* FUH/IET outcomes
* Readmission Rates
* Cost metrics
* Collaborate with network providers across all service levels
* Inpatient MH - Monthly, bi-monthly, or Quarterly as determined by UM tier
* review UM tier status with potential for movement based on ALOS trends
* IP SUD - Quarterly
* Diversionary - Quarterly
* Outpatient - Quarterly
* ESP - Quarterly
* Develop individualized strategic plans to improve provider performance towards established regional clinical and quality work goals
* HEDIS 90th percentile
* Increase IET rates
* ALOS targets based on providers' historical performance
* Community tenure
* Reduce readmission rates
* Create linkages between IP, OP, ACOs, BHCPs and/or other community-based services for improved transition of care planning.
* Facility-based care collaboration with targeted providers
* Weekly (or as appropriate) on-site meetings
* Rounding on Beacon members currently at facility
* Review transition of care planning, including barriers to improve rate of scheduled 7-day follow-up appointments post discharge
* Consultation for clinically complex members
* Observation of clinical and quality practices to identify opportunities for improvement
* Utilize member-level data to provide continuous feedback regarding post-discharge transition of care outcomes
* FUH/IET outcomes
* Readmissions to inpatient levels of care
* Advocacy with Acute Services Providers (telephonically and while at other Facility-based activities) relative to access to care, i.e. admissions referrals from ESPs, and consistent with the EOHHS/DMH Expedited Admissions Policy
* Analysis of proposals for additions to the Beacon network to determine need based on current network utilization and geo-access review
* Present analysis at weekly Quality Operations meetings
* New provider/facility seeking entry to the Beacon network
* Existing provider adding new sites/services to the Beacon network
* Partner with network providers and Beacon stakeholders to operationalize innovative programs or strategies to improve clinical and quality outcomes (i.e. VBP models)
* Conduct medical record reviews annually or as needed, with network providers across all service levels
* Serve as a liaison with internal Beacon departments to resolve provider issues
What you Contribute?

Education :Master's degree in Behavioral Health required

Licensure :Independently licensed behavioral health clinicians strongly considered

Knowledge, Skills & Abilities:

* Preferably five (5) years managed behavioral healthcare or related experience
* 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.
* A working knowledge of account management, customer relations and business management are essential
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
* 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 & well being 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!

Beacon Health Options 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 ( 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 you.




Closing Date:
Contact Details:
Beacon Health Options
Contact: N/A

You may return to your current search results by clicking here.

Latest Job Listings