Behavioral Health Provider Quality Manager

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Title: Behavioral Health Provider Quality Manager

Candidates must posses a licensure for the state of California.

Location: This role requires associates to be inoffice 12 days per week fostering collaboration and connectivity while providing flexibility to support productivity and worklife balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Schedule: Monday Friday; 8:00am 5:00pm Pacific Standard Time

This position may be required to travel out to the field as needed.

Build the Possibilities. Make an Extraordinary Impact.

Carelon Health is a proud member of the Elevance Health family of brands offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.

The Provider Quality Manager is responsible for leading Behavioral Health (BH) provider engagement with a focus on leveraging the data available to providers and helping to improve the value delivered to Carelon members. Drives BH provider performance improvement year over year through education and data. This role is responsible for a local market.

How will you make an impact:

Primary duties may include but are not limited to:

• Establishes relationships and engages with BH providers and ensures measurable improvements in clinical and quality outcomes for members.

• Builds relationships with internal clinical and quality departments to ensure highquality care to members and achievement of company HEDIS performance. Implements strategies that meet clinical quality and network improvement goals.

• Build positive working relationships with providers state agencies advocacy groups and other market stakeholders.

• Meets routinely with strategic providers face to face telephonically and via WebEx to support provider training on Carelon processes contracting / credentialing and linkages for issue resolution helping to improve provider experience and overall satisfaction with Carelon.

• Acts as a liaison between strategic providers and Carelon clinical quality provider strategy operations and claims to ensure interdepartmental collaboration and coordination of goals and priorities.

• Supports regional and corporate initiatives regarding Carelon Select Provider (CSP) program clinical innovation and thought leadership transforming provider relationships from transactional interactions to collaboration.

• Creates and maintains linkages between providers of all levels of care as well as other communitybased services and resources to improve transitions of care and continuity of services.

• Partners with network providers and Carelon stakeholders to operationalize innovative programs and online resources to improve clinical and quality outcomes.

• Analyzes provider reports pertaining to cost utilization and outcomes and presents the data to providers and highlights trends.

• Identifies data outliers and opportunities for improvement for individual providers.

• Identifies highperforming and innovative providers who may be interested in new programmatic incentives or payment models.

• Participates in the identification of opportunities for expansion and development of innovative pilot programs implementation launch and efficacy and outcomes measurements.

• Contributes to the identification of highquality program ideas/designs into the local market to drive high levels of value.

• Provides consultation to providers for clinically complex members as applicable.

• Surfaces clinical and quality issues to regional clinical and quality teams and participates in helping to address concerns.

• Conducts quarterly physician record reviews or as needed with network providers across all service levels.

• Assists with provider orientations and provider training events in the region when applicable.

• Attends all accessible County BH provider meetings either in person or via telephone or Webex.

Minimum requirements:

• Requires MA/MS or above in Behavioral Health field and a minimum of 10 years of progressively responsible professional experience in healthcare which includes a minimum of 5 years experience in a behavioral health setting either provider or payer; or any combination of education and experience which would provide an equivalent background.

• Current valid independent and unrestricted license such as RN LCSW LMFT LMHC LPC or Licensed Psychologist (as allowed by applicable by state laws) is required.

Preferred Skills Capabilities and Experiences:

• Behavioral Health experience preferred.

• Travels to the worksite and other locations as necessary preferred.

• Managed care experience preferred.

For candidates working in person or virtually in the below location(s) the salary* range for this specific position is $86480 $129720.

Location: California

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate nondiscriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender race or any other category protected by federal state and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success for our consumers our associates our communities and our business.

We offer a range of marketcompetitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.