Behavioral Health Provider Quality Manager

4 weeks ago

Jacksonville, Florida, United States Elevance Health Full time

Job Summary:

The Behavioral Health Provider Quality Manager is responsible for leading Behavioral Health (BH) provider engagement, with a focus on leveraging data to improve value delivered to Carelon BH members.

Key Responsibilities:

  • Drive BH provider performance improvement year over year through education and data.
  • Establish relationships and engage with BH providers to 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 through positive working relationships with providers, state agencies, advocacy groups, and other market stakeholders.
  • Meet with providers face-to-face, telephonically, and via Teams.
  • Act as a liaison between strategic providers and Carelon BH clinical, quality, provider strategy, network departments, operations, claims, and provider relations to ensure interdepartmental collaboration and coordination of goals and priorities.
  • Support regional and corporate initiatives regarding Alternative Payment Models (APMs), including Value-Based Payment (VBP), clinical innovation, and thought leadership.
  • Perform medical record and case management file reviews for enrollees who are high utilizers of CSU and inpatient psychiatric hospital services, Baker Act receiving facilities, and/or CSUs.
  • 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 BH stakeholders to operationalize innovative programs and strategies 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 or payment models.
  • Collaborate with regional leadership and network teams to identify providers who are best suited for APMs, preferred provider networks, and/or other aggregate data management programs.
  • Participate in the identification of opportunities for expansion and development of innovative pilot programs, including program development, implementation, launch, and efficacy and outcomes measurements.
  • Contribute to the identification of best practices and integrate 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 medical record reviews annually or as needed with network providers across all service levels.
  • Assist with provider orientations and provider training events in the region, when applicable.

Requirements:

  • Requires MA/MS or above in Behavioral Health field and minimum of 10 years of progressively responsible professional experience in healthcare, including a minimum of 5 years' experience in a behavioral health setting, either provider or payer.
  • Current, valid, independent, and unrestricted license such as RN, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist (as allowed by applicable state laws) is required.

About Elevance Health:

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.

  • Quality Manager

    4 weeks ago

    Jacksonville, Florida, United States Elevance Health Full time

    Job SummaryThe Behavioral Health Provider Quality Manager is responsible for leading Behavioral Health (BH) provider engagement, focusing on leveraging available data to improve the value delivered to Carelon BH members.Key ResponsibilitiesDrive BH provider performance improvement year over year through education and data.Establish relationships and engage...

  • Behavioral Health Services Manager

    4 weeks ago

    Jacksonville, Florida, United States Elevance Health Full time

    Job Title: Manager Behavioral Health ServicesAbout the Role:The Manager Behavioral Health Services will be responsible for leading a team of licensed clinicians and non-clinical support staff in the management of Behavioral Health Utilization Management (BH UM), Behavioral Health Case Management (BH CM), or a combination of both functions. The ideal...

  • Behavioral Health Therapist

    4 weeks ago

    Jacksonville, Florida, United States Unity Health Full time

    Job Summary:The Therapist will provide quality individual and group therapies, as well as oversee case management services to patients on the Behavioral health unit using professional standards, and according to their licensure and or certification.Responsibilities: Performs and documents a comprehensive systematic patient assessment in accordance with the...

  • General Adult Psychiatrist Position at River Point Behavioral Health

    1 month ago

    Jacksonville, Florida, United States River Point Behavioral Health Full time

    Opportunity OverviewRiver Point Behavioral Health, a leading provider of inpatient mental health services, is seeking a dedicated Psychiatrist to join their team. This esteemed facility offers 24-hour acute care for adults, addressing a wide range of mental health challenges including depression, anxiety, trauma, and more.Key Highlights:Competitive salary...

  • Quality Assurance Director

    3 weeks ago

    Jacksonville, Florida, United States River Point Behavioral Health Full time

    Job SummaryRiver Point Behavioral Health is seeking a highly skilled and experienced Director of Quality Assurance/Improvement and Compliance to join our team. This is a key leadership role that will be responsible for ensuring the highest standards of quality and compliance across our facilities.Key ResponsibilitiesCoordinates quality improvement and...

  • Director of Quality Assurance and Compliance

    1 month ago

    Jacksonville, Florida, United States River Point Behavioral Health Full time

    Job SummaryRiver Point Behavioral Health is seeking a highly skilled Director of Quality Assurance and Compliance to join our team. As a key member of our leadership team, you will be responsible for coordinating quality improvement and compliance activities across our clinical and support services.ResponsibilitiesCoordinate quality improvement and...

  • Director of Utilization Management

    4 weeks ago

    Jacksonville, Florida, United States River Point Behavioral Health Full time

    River Point Behavioral Health is a leading provider of behavioral health services, seeking a highly skilled and experienced Director of Utilization Management to join our team of dedicated healthcare professionals.Position Summary:The Director of Utilization Management is responsible for overseeing the Utilization Management Department, ensuring the...

  • Behavioral Health Care Provider

    7 days ago

    Jacksonville, Florida, United States Choctaw Staffing Solutions Full time

    Job Summary: Choctaw Staffing Solutions is seeking a highly skilled Mental Health Counselor to join our team. In this role, you will provide behavioral health services to Special Operations personnel and their families. This is a unique opportunity to work with a dynamic team and make a meaningful impact on the lives of service members and their loved ones. ...

  • Behavioral Health Specialist

    4 weeks ago

    Jacksonville, Florida, United States Mental Health Resource Center Inc Full time

    Job Summary:This is an ideal opportunity for an individual who enjoys working in a team atmosphere and is dedicated to providing both behavioral health care and social services to the individuals we serve in the community.The FACT Program is a multi-disciplinary, clinical team that assumes responsibility for directly providing needed treatment,...

  • Instructional Aide

    4 weeks ago

    Jacksonville, Florida, United States ChanceLight Behavioral Health, Therapy, & Education Full time

    Job SummaryChanceLight Behavioral Health, Therapy, & Education is seeking an Instructional Aide to join our team. As an Instructional Aide, you will provide individualized supervision and instruction to assigned students and additional support to the core classroom staff.ResponsibilitiesImplementing curriculum and behavioral intervention strategies...

  • Healthcare Professional

    1 month ago

    Jacksonville, Florida, United States Universal Health Services Full time

    Job Summary:As a Registered Nurse with Universal Health Services, you will play a vital role in providing high-quality patient care in a dynamic and supportive environment. Our team is dedicated to delivering exceptional healthcare services, and we are seeking a skilled and compassionate Registered Nurse to join our Behavioral Health team.About the Role:As a...

  • Senior Social Worker

    4 weeks ago

    Jacksonville, Florida, United States Veterans Affairs, Veterans Health Administration Full time

    Job SummaryWe are seeking a highly skilled Senior Social Worker to join our Behavioral Health Interdisciplinary Program (BHIP) team at the Veterans Affairs, Veterans Health Administration. As a Senior Social Worker, you will play a vital role in providing comprehensive assessments, individual and group treatment, and medication management to our Veterans.Key...

  • Registered Nurse

    4 weeks ago

    Jacksonville, Florida, United States Universal Health Services Full time

    About the Role:Universal Health Services is seeking a dedicated Registered Nurse to join our team at River Point Behavioral Health. As a key member of our healthcare team, you will be responsible for providing high-quality patient care and implementing the nursing process in all aspects of treatment.Key Responsibilities:Implement the nursing process in all...

  • Nurse Practitioner

    4 weeks ago

    Jacksonville, Florida, United States Universal Health Services Full time

    At Universal Health Services, we are committed to providing compassionate, comprehensive care to our patients. As a Registered Nurse in our Behavioral Health program, you will play a critical role in implementing the nursing process to ensure the best possible outcomes for our patients.Responsibilities:Implement the nursing process in all aspects of patient...

  • Behavioral Health Specialist

    4 weeks ago

    Jacksonville, Florida, United States Acadia Healthcare Full time

    Job Summary:We are seeking a skilled Nurse Practitioner to join our team at Acadia Healthcare. As a key member of our outpatient addiction medicine program, you will play a critical role in providing high-quality care to patients struggling with substance use disorders.Responsibilities:Conduct initial and annual history and physical evaluations to assess...

  • Admissions Nurse

    4 weeks ago

    Jacksonville, Florida, United States Universal Health Services Full time

    As an Admissions Registered Nurse with Universal Health Services, you will play a vital role in ensuring the smooth transition of patients into our care. Your primary responsibility will be to complete thorough assessments for patient admissions, providing a comprehensive understanding of their medical history and current condition.Responsibilities...

  • RN Night Nurse

    4 weeks ago

    Jacksonville, Florida, United States Lakeview Health Full time

    Job SummaryAt Lakeview Health, we are seeking a dedicated RN Night Nurse to provide exceptional patient care services in our behavioral health setting. As a Night Nurse, you will be responsible for delivering direct and indirect patient care services that meet the psychosocial, physical, and general aspects of patient care while maintaining effective...

  • PRN Registered Nurse

    1 month ago

    Jacksonville, Florida, United States Universal Health Services Full time

    About the Role:Universal Health Services, Inc. is seeking a PRN Registered Nurse to join our team at River Point Behavioral Health. As a PRN Registered Nurse, you will be responsible for implementing the nursing process in all aspects of patient care for various patient populations.Responsibilities:Implement the nursing process in all aspects of patient care...

  • Part Time RN Nurse

    4 weeks ago

    Jacksonville, Florida, United States Lakeview Health Full time

    Job SummaryAt Lakeview Health, we are seeking a dedicated and compassionate Registered Nurse to join our team. As a Part Time RN Nurse, you will provide direct and indirect patient care services that meet the psychosocial, physical and general aspects of patient care while meeting the communication needs of the patient and family.Responsibilities Provide...

  • Quality Team Lead

    4 weeks ago

    Jacksonville, Florida, United States Mental Health Resource Center Inc Full time

    About the Role: Mental Health Resource Center Inc is seeking an experienced Quality Team Lead to join our team. This role is responsible for ensuring the highest quality of services delivered to our clients.Job Summary: The Quality Team Lead will be responsible for the development and implementation of a plan for monitoring and reporting the Agency's...