AVP/Director, Regional Provider Quality - Northeast Region in Woburn, MA at Beacon Health Options

Date Posted: 1/29/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic AVP/Director, Regional Provider Quality who will serve as a visionary leader who implements, and revises regional provider engagement strategy through aggregate data, transforming the provider/payer relationship to one of collaboration towards improved member outcomes, high levels of provider satisfaction and improvement in healthcare costs.

Mission: To serve as a visionary leader who implements, and revises regional provider engagement strategy through aggregate data, transforming the provider/payer relationship to one of collaboration towards improved member outcomes, high levels of provider satisfaction and improvement in healthcare costs.

Position Responsibilities:

  • Own integration of provider strategy with Clinical/Quality vision in the region
    • Develop and implement regional provider strategy, together with Regional Clinical Quality Lead, UM Shared Services, Provider Strategy, and RCOO, when applicable.
    • Identify strategic or targeted providers in the given market, working with aggregate data availability to identify providers that would provide the greatest opportunity to align with regional provider strategy
    • Regularly evaluate success of regional Provider Quality programming against client demands as communicated by RCQL or VPs, Account Partnerships
    • Establish areas where provider benchmarks are needed, working with Regional Clinical/Quality lead to determine provider benchmarks
    • Identify strategies to engage providers in Clinical/Quality vision in the region, including development of provider-facing materials, prioritizing multiple initiatives, provider advisory councils, and oversight of provider performance
    • Work with Regional Clinical/Quality leadership to identify novel opportunities and support aggregate utilization management to engage provider high-performers as well as underperformers

  • Lead regional team of Provider Quality Staff, including Managers of Provider Partnerships (MPP), Select clinicians and other provider-facing data roles
    • Track MPP productivity, impact, and performance by region, MPP, and provider
    • Support regional activities (technical assistance, site visits, UM follow-up, case rounding, select models)
    • Organize MPP rounds provide oversight on provider data and messaging
    • Oversee MPP performance through on-site observation and audits of MPP documentation
    • Decision maker for all MPP hires with input from Corporate Provider Quality, implement MPP training model for all new hires, oversight for all MPPs.
    • Aggregate provider feedback to inform both regional operations and identify possible best practices in the market
    • Escalate and/or prioritize provider issues with Ops Pod leaders
    • Develop region-specific provider materials together with MPPs to support HEDIS BH measures and other Clinical/Quality initiatives
    • Implement Select and VBP strategies with providers in the assigned region based on national standards to meet regional needs

  • Monitor provider performance and measure impact of Provider Quality programs using aggregate data and member outcomes
    • Become an expert on datasets and reports relevant to Provider Quality, including the Provider Profiler, Value-Based Payment reports, and Provider Select reports
    • Train all staff how to effectively understand, leverage, and communicate the reports when engaging providers
    • Drive decision-making that leverages the aggregate data available in the various reports in order to improve member outcomes
    • Collaborate with Corporate Provider Quality to identify regional needs for aggregate data and maintain active dialogue around Provider Profiler changes, updates, and application to region
    • Create and provide regional provider data requests, including coordinating regional data requests outside of Provider Profiler, VBP, and Select reports
    • Develop and implement a quantitative provider engagement metric in line with regional goals

  • Oversee and Monitor Key Performance Indicators
    • Quantitative
      • Performance against Provider Strategic Plans
      • Regional Provider engagement in Provider Quality programs
      • HEDIS BH measures
    • Qualitative
      • Provider Strategic plans developed for all participating providers including goals against clinical strategy with provider
      • Effective partnership with Provider Strategy, UM Shared Services, Ops Pods, etc.
      • Talent development and coaching
      • Provider role and needs integrated into Clinical/Quality vision and infrastructure

Position Requirements:

  • Education: Master’s degree in Behavioral Health field required
  • Licensure:  License-eligible or currently licensed in any state
  • Relevant Work Experience:  5-7 years of progressive experience, with at least 3-5 years of experience in a supervisory role and 2 years experience in a Behavioral Health profession
  • Knowledge, Skills & Abilities:
    • Direct service provision or experience working in the provider community required
    • Leadership skills and supervisory experience, including the ability to develop team performance
    • Excellent written and oral communication skills
    • Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.
    • Ability to manage and coordinate with internal and external departments
    • Ability to manage staff in operations environment
    • Demonstrated leadership skills and experience, including the ability to work cross-functionally, build consensus and develop staff  
    • Ability to manage time-sensitive projects and meet deadlines
    • Ability to identify opportunities for improvements and recommend and implement innovative solutions.
    • Able to work collaboratively with internal staff and external providers
    • Must be detail oriented; able to work independently in an ever changing environment
    • Must have excellent communication and negotiation skills.

To Apply:

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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