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Anthem, Inc. Beacon Clinical Programs Director in Lakewood, Washington

Description

SHIFT: Day Job

SCHEDULE: Full-time

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon 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.

Beacon Clinical Programs Director

Work Location – Washington State

The Clinical Program Director implements and manages crisis provider engagement strategies regionally as well as statewide, in the administration of services in accordance with contractual terms and state regulations. The Clinical Program Director is responsible for supporting a collaborative provider/payer relationship to improve member outcomes, maintain high levels of provider satisfaction and for improving healthcare costs. The Clinical Program Director assists in implementing best practices, executes on regional goals for the crisis system, provides technical assistance and addresses provider performance issues to ensure the crisis system is functioning at the highest level.

Duties and Responsibilities include but are not limited to the following:

  • Integration of provider strategy with clinical/quality vision in the region

    • Develop and implement regional provider strategy, partnering with leadership in clinical, quality, UM and other shared service SMEs across the enterprise.

    • Analyze aggregate data and conduct targeted research to identify providers in the given market that would provide the greatest opportunity to align with regional provider strategy.

    • Evaluate success of regional programming initiatives against client demands to demonstrate ROI and inform strategic approach.

    • Establish and implement provider benchmarks, in partnership with clinical, quality and other shared service SMEs across the enterprise.

    • Identify strategies to engage providers in Clinical/Quality vision in the region, including development of provider-facing materials, prioritizing multiple initiatives, provider advisory councils, and oversight of provider performance

    • Work closely with clinical and quality leadership to identify novel opportunities and support aggregate utilization management to engage provider high-performers and navigate underperformers.

    1. Drive development of Crisis Systems of Care, in collaboration with Account Partnership and other provider facing roles

    • Establish a statewide vision for Crisis Systems of Care and develop benchmarks, key performance indicators, opportunities to influence state policy to achieve the vision

    • Develop a person centered crisis continuum that is focused on prevention and early intervention

    • Drive crisis provider performance through the use of data, value based contracting

    methods and implementation of innovative clinical best practice

    • Engage crisis providers statewide in executing against contractual terms and state regulations.

    • Provide technical assistance to crisis providers in achieving performance standards and regional crisis system goals.

    • Convene crisis providers across regions for cross learning opportunities

    • Lead crisis collaboratives as appropriate

  • Monitor provider performance and measure impact of Provider Quality programs using aggregate data and member outcomes

    • Serve as an expert on datasets and reports relevant to Provider Quality, including the Provider Profiler, Value-Based Payment reports, and Provider Select reports

    • Train all staff how to effectively understand, leverage, and communicate the reports when engaging providers

    • Influence decision-making that leverages the aggregate data available in the various reports in order to improve member outcomes

    • Collaborate with shared service partners to identify regional needs for aggregate data and maintain active dialogue around Provider Profiler changes, updates, and application to region

    • Create and provide regional provider data requests, including coordinating regional data requests outside of Provider Profiler, VBP, and Select reports

    • Develop and implement a quantitative provider engagement metric in line with regional goals

    1. Oversee and Monitor Key Performance Indicators

    Quantitative

    • Performance against Provider Strategic Plans

    • Regional Provider engagement in Provider Quality programs

    • Crisis system performance measures

    Qualitative

    • Provider Strategic plans developed for all participating providers including goals against clinical strategy with provider

    • Effective partnership with Provider Strategy, UM Shared Services, Ops Pods, etc.

    • Provider role and needs integrated into Clinical/Quality vision and infrastructure

    6+ years of progressive experience, with at least 3-5 years of experience in a supervisory role

    Minimum of 2 years’ experience in a Behavioral Health profession

    Direct service provision or experience working in the provider community required

    Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2020 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS48670

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