MANAGER, BEHAVIORAL HEALTH PROVIDER CONTRACTING
Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.
Working under the direction of the Director of Provider Contracting, Ancillary and Community Based Services, the Manager, Behavorial Health (BH) Provider Contracting will be responsible for provider recruiting and contracting efforts required to maintain an adequate network of behavioral health providers to meet the needs of CCA members.ESSENTIAL DUTIES AND RESPONSIBILITIES:
QUALIFICATIONS & REQUIREMENTS:
- Lead the development and maintenance of the CCA behavioral health provider networks through the management of behavioral health contract negotiations, provider partnership development, provider recruitment, reimbursement design, and supervision of contracting staff, as appropriate. Directly develop, negotiate and manage specific behavioral health contracting efforts, especially related to high visibility corporate projects or specialized contracting initiatives such as pay for performance programs, risk-based or shared savings models, or other alternative payment structures.
- Direct contracting or oversight of staff contracting may include, but not be limited to, services such as all behavioral health in-patient, out-patient, and diversionary services; dual diagnoses programs; in-patient and out-patient detoxification facilities and addiction programs, etc. Provider types may include, but not be limited to, individual psychiatrists, psychologists and clinical licensed social workers, in-patient hospitals and all behavioral health facilities, out-patient clinics and human service organizations.
- Strategize and prioritize BH provider recruitment and re-contracting activities in compliance with regulatory and corporate requirements and to meet fast-paced growth environment.
- Effectively and professionally represent CCA with providers and provider organizations.
- Maintain positive working relationships with contracted providers, systems, and institutions.
- Identify synergy between CCA and potential new providers, and effectively implement and maintain these new BH provider partnerships.
- Effectively promote and convey the concept of CCA’s Care System Design of full integration of medical, behavioral health and long-term care services to new providers.
- Assist Director and department in the development and maintenance of work flows and processes, to streamline and maximize efficiencies for contracting and out of network, single case agreements.
- Provide supervision and management of staff which may include contract managers and specialists, as appropriate, and including development of performance metrics and management tools to foster an environment of professionalism and performance excellence.
- Provide coaching, mentorship, teaching, support, and oversight in the BH contracting and contract negotiation process, drawing upon experience and subject matter expertise.
- Collaborate with and build strong partnerships across the organization to align BH network recruitment and management activities with membership and clinical care goals, regulatory compliance, company growth targets, and other organizational priorities.
- Possess a solid understanding of Medicare and Medicaid reimbursement methodologies for BH services, especially for, but not limited to: services such as all in-patient, out-patient, and diversionary services; dual diagnoses programs; in-patient and out-patient detoxification facilities and addiction programs, and provider types such as, but not limited to, individual psychiatrists, psychologists and clinical licensed social workers, in-patient hospitals and all behavioral health facilities, out-patient clinics and human service organizations.
- Actively participate in the evaluation of own performance.
- Bachelor’s Degree Required; Master’s Preferred in Business, Public Health, Public Policy, or related field.
- Minimum 5 years of work experience in health care settings with strong managed care contracting experience.
- Experience with behavioral health provider contracting, contract terms and health care reimbursement required. Knowledge of Medicaid and Medicare programs and reimbursement methodologies, especially for BH services.
- Knowledge of a range of BH provider types, including but not limited to individual psychiatrists, psychologists and clinical licensed social workers, in-patient hospitals and all behavioral health facilities, out-patient clinics and human service organizations, etc.
- Specific background in complex managed care provider contracting including and/or other high level and complex contracting required.
- Comprehensive understanding of reimbursement methodologies and health care financing required.
- Solid understanding of Medicare and Medicaid reimbursement methodologies and particular expertise in Medicare and Medicaid health care services contracting strategies.
- Understands provider health care delivery systems both large and small, and is able to implement and perform complex contracting strategies and negotiations.
- Demonstrated abilities in staff supervision, motivation, and management.
- Ability to work cross functionally to set priorities; build partnerships; meet internal customer needs; and obtain support for department initiatives.
- Ability to plan, organize, and manage own work and that of direct reports; set priorities and measure performance against established benchmarks.
- Ability to identify, develop, track, and measure key performance metrics.
- Ability to communicate and work effectively at multiple levels within the company.
- Customer service orientation; positive outlook, self-motivated and able to motivate others.
- Strong work ethic; able to solve problems and overcome challenges.
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws