Behavioral Health Community Partnership Manager

Behavioral Health Provider Quality Manager

Sign on Bonus: $2,500

Candidates must possess a license for the state of California.

Location:

The ideal candidate will reside in or near Sacramento, Shasta or Humboldt counties. This role enables associates to work virtually as well as in the field for client visits, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face meetings.

This position will be required to travel out to the field as needed in Northern California.

Schedule:

Pacific Standard Time

A proud member of the Elevance Health family of companies, Carelon Behavioral Health (formerly Beacon Health Options), offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

• Establish relationships and engage with BH providers and ensure measurable improvements in clinical and quality outcomes for members.
• Build relationships with internal clinical and quality departments to ensure high‑quality care to members and achievement of company HEDIS performance. Implement strategies that meet clinical, quality, and network improvement goals.
• Build positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders.
• Meet routinely with strategic providers face‑to‑face, telephonically, and via Web‑Ex to support provider training on Carelon processes, contracting/credentialing and linkages for issue resolution, helping to improve provider experience and overall satisfaction with Carelon.
• Act 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.
• Support regional and corporate initiatives regarding Carelon Select Provider (CSP) program, clinical innovation, and thought leadership transforming provider relationships from transactional interactions to collaboration.
• Create and maintain linkages between providers of all levels of care, as well as other community‑based services and resources to improve transitions of care and continuity of services.
• Partner with network providers and Carelon stakeholders to operationalize innovative programs and online resources to improve clinical and quality outcomes.
• Analyze provider reports pertaining to cost, utilization, and outcomes, and present the data to providers and highlight trends.
• Identify data outliers and opportunities for improvement for individual providers.
• Identify high‑performing and innovative providers who may be interested in new programmatic incentives or payment models.
• Participate in the identification of opportunities for expansion and development of innovative pilot programs, implementation, launch, and efficacy and outcomes measurements.
• Contribute to the identification of high‑quality program ideas/designs into the local market to drive high levels of value.
• Provide consultation to providers for clinically complex members as applicable.
• Surface clinical and quality issues to regional clinical and quality teams and participate in helping to address concerns.
• Conduct quarterly physician record reviews or as needed with network providers across all service levels.
• Assist with provider orientations and provider training events in the region, when applicable.
• Attend all accessible County BH provider meetings either in person or via telephone or Web‑ex.

• 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 state laws) is required.