Senior Manager of Behavioral Health Program Performance

WellSense Health Plan; Charlestown (MA, NH); Remote; USD 80,000 - 110,000; Full time

Job summary

An established industry player is seeking a Senior Manager of Behavioral Health Program Performance to lead initiatives that enhance member care and ensure high-quality outcomes. This pivotal role involves collaborating with various departments to track and resolve clinical issues while guiding strategic quality initiatives. The ideal candidate will possess a deep understanding of behavioral health regulations and a proven ability to manage projects effectively. Join a dynamic team committed to making a difference in the lives of its members through innovative health solutions.

Benefits

Full-time remote work

Competitive salaries

Excellent benefits

Qualifications

• 5+ years of experience in behavioral health or managed care.
• Master's degree in a relevant field is required.

Responsibilities

• Oversee behavioral health performance deliverables and quality initiatives.
• Lead teams to improve health outcomes and prevent hospital readmissions.

Skills

Leadership

Project Management

Behavioral Health Knowledge

Analytical Skills

Communication Skills

Education

Master's Degree in Social Work

Licensed Independent Clinical Social Worker

Tools

Microsoft Office

Job description

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:

At the direction of the Senior Director of Behavioral Health Programs and Strategy, the Senior Manager of BH Program Performance is responsible for oversight of all behavioral health performance related deliverables. The position is the BH liaison with internal clinical departmental staff and external regulatory and key stakeholder contacts as appropriate related to the tracking and resolution of clinical treatment concerns, issues related to WellSense member care, as well as the lead internal resource guiding efforts to build and coordinate integrated medical / BH opportunities. By virtue of clinical and quality subject matter expertise, deep understanding of the behavioral health and related regulatory environment and requirements, recommends and implements strategy related to high quality outcomes impacting member care. Leads the BH Quality and BH Provider Performance teams.

The position is self-directed with exposure to all levels of management and external governmental agencies at the direction of Behavioral Health senior leadership.

Our Investment in You:

*Full-time remote work

*Competitive salaries

*Excellent benefits

Key Functions/Responsibilities:

• Recommends and implements strategic initiatives related to provider quality performance, including value based payment opportunities.


• Works closely with counter-part functional areas within WellSense to ensure that a holistic approach to ensuring quality outcomes and related provider performance is achieved.


• Provides consultation on BH clinical management needs and strategy related to contract deliverables, identifying solutions to new and changing program requirements for both NH and MA business.


• Provides clinical guidance on complex member issue resolution specific to MA and NH business, working with the Clinical, Provider, Quality and Public Partnerships departments as required to resolve member specific issues expeditiously, to resolve clinical system barriers to member treatment and care and to promote clinical continuous quality improvement related to BH treatment within both the WellSense and BH material subcontractor systems.


• Accountable for tracking, analyzing, responding to BH Material Subcontractor management and regulatory reporting, inclusive of necessary corrective action plans when performance standards are not met.


• Works collaboratively with the Quality, Clinical, Network and Public Partnership departments to oversee the quality and provider performance components of the BH program, to improve health outcomes and prevent hospital readmissions


• Leads the BH Quality and BH Provider Performance teams to support WellSense departmental collaboration impacting targeted quality metrics as well as strategic provider stakeholders across markets to ensure that providers have the actionable data and tools needed to support positive member health related outcomes.


• As appropriate, serves as liaison to Executive Office of Health and Human Services (EOHHS) Office of Behavioral Health and Department of Health and Human Services (DHHS) contract managers specific to Adverse Incident reporting and investigation, Quality of Care concerns, regulatory reporting, and ad hoc clinical, quality and reporting requests as appropriate, to ensure facility use of best clinical practices to avoid harm


• Leads the health plan in strategic BH quality initiatives related to corporate goals, strategic operating priorities, NCQA accreditation and the Plan's HEDIS submission.


• Advises and supports the Quality department related to confirmation of NCQA accreditation evidence documentation and approval.


• When appropriate, leads management of other contractual or clinical relationships supporting BH


• Medical integration


• Serves as the technical assistance liaison for the Office of Clinical Affairs to work with internal and external stakeholders to support implementation of and alleviate barriers towards BH


• Medical integration models


• Facilitates interdepartmental efforts and / or structures efforts with BH material subcontractor to meet goal of appropriate initiatives and projects as defined by the Senior Director of BH Programs and Strategy and Behavioral Health senior leadership.


• Identifies, tracks and monitors clinical staff training opportunities.


• Other functions as required to support departmental activities, to include overall day to day resolution of BH operational issues, as appropriate and assigned.


• Regular and reliable attendance is an essential function of the position.

Supervision Exercised:

• Direct supervision scope of 3-8 direct reports; capable of managing 10-20 FTEs on project teams.

Supervision Received:

• General direction is received weekly

Qualifications:

Education Required:

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

Education Preferred:

• Licensed Independent Clinical Social Worker or other applicable licensure for MA preferred

Experience Required:

• 5+ years behavioral health specific health care / managed care experience.


• Experience in vendor or contract management


• In depth knowledge of and experience with clinical BH quality management and related business goals and practices within related areas.


• Experience with Medicaid populations

Experience Preferred/Desirable:

• Experience with Medicaid recipients and community services.


• Prior Behavioral Health Management experience.


• Experience in project development and / or health policy.

Required Licensure, Certification or Conditions of Employment:

• Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• Demonstrated ability in leading / facilitating cross functional teams


• Demonstrated ability to successfully plan, organize and manage high impact projects


• Demonstrated ability to work independently and manage multiple projects simultaneously


• Effective collaborative and proven process improvement skills.


• 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.


• Detail oriented, excellent proof reading and editing skills.

Working Conditions and Physical Effort:

• Ability to work OT during peak periods. (Non-Exempt Positions)


• 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