• Behavioral Health Manager

    Job Locations US-RI-Smithfield
    Req No.
    2018-9611
    Department
    Behavioral Health
    Type
    Regular Full-Time
  • Overview

    This position is responsible for the implementation, monitoring and management of the Behavioral Health (BH) vendor relationship as it relates to new and existing lines of business. This includes responsibility for programming, reimbursement design and measurements as appropriate. Work closely with stakeholders to develop, negotiate and manage specific BH 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. He/she will also be accountable for managing and maintaining positive working relationships with the State, providers and other community stakeholders to achieve organizational goals.

    Responsibilities

    • Responsible for  day-to-day management and oversight of the company’s BH vendor, including vendor’s compliance with purchasing specifications, performance standards, QI activity, implementation of the new lines of business and new services to meet members’ BH needs
    • Lead implementation of new benefits inclusive of directing vendors system builds, working directly with state agencies and providers, and decision making regarding programming, billing and measurements
    • Development and implementation of project plans to meet required results including cost initiative related to new services, programs and lines of business
    • Leads cross functional teams to meet company goals for BH
    • Serves as the department’s subject matter expert at internal and external meetings as needed
    • Evaluates BH trends to identify and implement changes in process and policy to improve financial and quality outcomes
    • Subject matter expert for State agencies and community based providers for new implementations
    • Strategize and prioritize BH provider recruitment and re-contracting activities in compliance with regulatory and corporate requirements and to meet fast-paced growth environment
    • Assist Director and department in the development and maintenance of work flows and processes to streamline and maximize efficiencies within the department’s function
    • Work closely with the Director and other stakeholders to provide support in the contracting and contract negotiation process
    • Collaborate with and build strong partnerships across the company to align network recruitment and management activities with membership and clinical care goals, regulatory compliance, company growth targets and other company priorities
    • Possess a solid understanding of Medicare, Exchange 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
    • Other duties as assigned
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

    Qualifications

    Required:   

    • Bachelor’s degree in Business or Health-related discipline
    • Five (5) years’ experience in Medicaid behavioral health service implementation
    • Five (5) years’ experience working with state agencies (i.e. EOHHS, DCYF, BHDDH) and community based providers
    • Project Management experience
    • Solid organization and analysis skills with demonstrated ability to deliver on multiple assignments, meet tight deadlines
    • Excellent verbal, written, and quantitative analysis skills
    • Computer Skills required (Word, Excel, Visio and Project Management Software)
    • Knowledge of Medicare and Medicaid regulations
    • 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; 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

    Preferred:

    • Experience in vendor oversight to achieve organizational goals
    • Knowledge of Quality Improvement Process and experience and/or familiarity with NCQA and HEDIS, including chart review
    • Knowledge of the company’s mission and populations
    • Licensed Behavioral Health clinician with Three (3) to Five (5) years of managed behavioral health
    • Comprehensive understanding of reimbursement methodologies and health care financing
    • Solid understanding of Medicare, Exchange and Medicaid reimbursement methodologies and particular expertise in Medicare, Exchange and Medicaid health care services contracting strategies
    • Understands provider health care delivery systems, contracting strategies and negotiations

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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