DIR REGIONAL PROVIDER QUAL in Cypress, CA at Beacon Health Options

Date Posted: 10/6/2018

Job Snapshot

Job Description


We are currently seeking a dynamic 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.

Position Responsibilities:

Own integration of provider strategy with Clinical/Quality vision in the region

    • Develop and implement regional provider strategy, together with Vice President, Regional Clinical and Quality Operations, 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 Vice President, Regional Clinical and Quality Operations 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

  1. Quantitative

  • Performance against Provider Strategic Plans

  • Regional Provider engagement in Provider Quality programs

  • HEDIS BH measures

b.  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

Minimum of 2 years experience in a Behavioral Health profession

Direct service provision or experience working in the provider community required

Knowledge, Skills & Abilities:

    • 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.


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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