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Regional Director Provider Quality

Job Description ABOUT THE POSITION We are currently seeking a strategic Regional Director Provider Quality to join our team at our office in Boston, MA.  Reporting to the AVP of Provider Quality, the Regional Director of Provider Quality plans, manages, and ensures quality in the Beacon Health Options (Beacon) provider network and care delivery system, including both the behavioral health and the primary care clinician network.  Will coordinate and build constructive relationships with behavioral health, primary care, and specialty medical providers; state agencies; consumer/family/advocacy organizations; and other stakeholders.  He/she will have a focus on utilization management as well as quality initiatives and priorities.  Position Responsibilities: Provider Quality Operations Assists the AVP of Provider Quality in the areas of network and clinical operations, policy and procedure development, quality management, and utilization management.Provides input and feedback to the AVP and Director of Provider Quality related to department procedures and concerns.Implements Beacon Health Options clinical and network policy/procedure guidelines.Provides internal and external reporting. Serves as liaison between Beacon Health Options and network providers, both behavioral health and primary care.Manages provider performance toward established goals, offering consultation and clarification of Beacon policies and directives.Educates providers regarding Beacon policies and procedures.Provides follow-up to complaints regarding network providers to assure efficient complaint resolution. Provides leadership to regional staff, including provider quality managers working with behavioral health providers.Directs clinical team activity in conjunction with clinical leadership within the region.Supervises and develops regional staff. Ensures positive relationships with state agencies and consumer and advocacy groups.Serves as the primary liaison with all state agency regional/area leadership. Coordinates provider quality and "macro" utilization management activities and strategies across all Beacon health plans including but not limited to inpatient utilization management, data systems including Cognos, Webe, profile data, outpatient utilization, SUD utilization, etc. Coordinates, collaborates, problem solves and communicates on behalf of the department with other departments across Beacon including but not limited to credentialing, reporting, clinical, quality, claims, etc. Provides leadership in the region for quality interventions. Serves as an expert on datasets and reports relevant to provider quality, including the provider profiles, value-based payment reports, and provider select reports Trains regional staff how to effectively understand, leverage, and communicate reports when engaging providers Training Conducts ongoing assessment of regional staff training needs; plans and facilitates staff training and the development of training materials in consultation with AVP of Provider Quality. Provides data trainings for staff and stakeholders including customers. Data and Reporting Conducts data analysis to support provider quality initiatives (examples include preparation for rate meetings, data re: outlier analysis for various levels of care) Facilitates data-driven decision making throughout all functions, including training regional staff on available data systems, conducting data analysis, writing data analysis summaries, formulating recommendations, and incorporating data into workgroups and other functions. Other Represent the department at external events, meetings, and workgroups as assigned. Complete other responsibilities as assigned. Position Requirements: Education: Master's degree in a behavioral health field Licensure:  Appropriate licensure in a behavioral health field Relevant Work Experience:  Minimum 5 years post-graduate clinical experience; program and management experiencepreferred; managed care experiencepreferred; provider network management experiencepreferred; understanding of data and its use in network management preferred Knowledge, Skills & Abilities: Knowledge of and experience with recovery principles and practices preferred Understanding of behavioral health system of care in the Northeast required Experience in working with value-based payment models, include sub-capitation arrangements with providers is required Strong analytical and problem solving skills a must Proficiency with MS Office (Word, Excel, PowerPoint, Outlook) Access to a vehicle and willingness to travelrequired 56165
Salary Range: NA
Minimum Qualification
5 - 7 years

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