Behavioral Health Network Operations Manager - Growing Organization
Behavioral Health Network Operations Manager - Growing Organization
Fallon Health
Worcester, MA
Job ID : 374f2f7156306c2b6c514e782f64433948513d3d
Job Description :
Overview:
Brief Summary of Purpose:
Fallon Health Vaccination Requirements:
About Fallon Health:
Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.
Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.
Brief Summary of Purpose:
The Behavioral Health Network Operations Manager serves as the primary liaison between Fallon and its BH Vendor(s) and Provider(s). This position is responsible for the analysis, design, implementation, readjustment, evaluation, and continuous improvement of vended behavioral health services and contracts. The BH Network Operations Manager will collaborate with internal and external stakeholders to manage financial and performance arrangements, contract implementations, day-to-day operational issues, associated projects, and instituting and monitoring operational metrics. This position will collaborate with internal departments and subject matter experts at all levels to support the governance of the vendor contract relationship, including prioritizing multiple requests by internal/external stakeholders, managing joint operating meetings, managing any potential changes in scope of vendor contract, and overseeing problem resolution and corrective action plans. The position also serves as the primary POC for the Fallon Health's Regulatory & Compliance as it relates to behavioral health.
Responsibilities:
Job Responsibilities:
- Serve as primary liaison between Fallon Health and its BH Vendor(s) and Provider(s).
- Ensures the design, production, and distribution of site financial, utilization and member information; ensures the production and completeness of annual site settlement reports.
- Performs quantitative analyses of various financial and clinical data to evaluate multiple contracting options.
- Identifies and implements continuous enhancements and efficiencies associated with vendor management; Reports performance of ongoing contractual arrangements to appropriate parties.
- Establishes and monitors performance guarantees (PGs) ensuring vendor accountability.
- In collaboration with internal FCHP Departments, work with BH Vendor(s) / Provider(s) to develop, refine, and produce standard reporting packages.
- Manages, coordinates, and resolves operational issues related to specific areas of responsibility.
- Serves as contact person for internal departments (Care Services, Claims, Finance, NDM, Member Services, Marketing, Provider Services, Legal).
- Collaborates with internal and external teams to promote behavioral health integration.
- Coordinates and communicates contractual information to appropriate departments within FCHP.
- Serves as committee member in cross-functional teams as assigned by Director of Behavioral Health Operations or designee.
- Analyzes and presents financial reports to BH vendor/provider. Makes recommendations regarding quality and cost improvements.
- Develops and institutionalizes operational metrics.
- Research, collection, tracking and reporting of vendor metrics.
- Develops and maintains vendor scorecard to be reviewed with vendor and internal departments and stakeholders.
- Conducts vendor meetings to review vendor performance linked to regulatory compliance and contractual obligations
- Tracks escalated issues and reporting of root cause analysis.
- Troubleshoots all vendor problems and presents to management as required.
Education:
- Bachelor’s degree required.
- Master’s degree in Healthcare Administration, Healthcare Analytics, MPH, MBA or other related field, preferred but not required.
License/Certifications:
Licensure as a mental health or SUD professional (e.g., LMHC, LCSW, LICSW, LADC1, etc.) is preferred but not required.
Experience:
- Minimum of seven-year(s) experience in managed healthcare environment(s) working with public sector programs or equivalent experience with related work in provider/healthcare vendor contracting, provider/healthcare vendor relations, healthcare finance, and provider reporting/profiling.
- Experience in provider contract negotiations, including FFS, capitation models, and pay for performance models is preferred.
- Strong operational skills and experience with behavioral health integration, alternative payment models, innovative care delivery models, and SUD treatment models is highly desirable.
- Solid knowledge of state and federal Behavioral Health related regulations.
- Analytical, strategic thinking, and creative thinking skills are required.
- Excellent verbal, written and computer skills (Microsoft Word, Excel, Power Point, Project) are essential to explain and document complicated financial and operational agreements between Fallon Health and its BH Vendor(s) / BH Provider(s).
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Fallon Health Vaccination Requirements:
To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Company Details :
Name : Fallon Health
CEO : Richard Burke
Headquarter : Worcester, MA
Revenue : $1 to $5 billion (USD)
Size : 1001 to 5000 Employees
Type : Nonprofit Organization
Primary Industry : Insurance Carriers
Sector Name : Insurance
Year Founded : 1977
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Details
: Worcester, MA
: 9 days ago
