Behavioral Health Population Health Manager
PacificSource

Job Info

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Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

This position is responsible for building and leading a Behavioral Health Population Health department to ensure implementation of a multi-year behavioral health (BH) transformation/improvement strategy focused on integrated, outpatient, specialty and residential behavioral health along integrated physical and behavioral health with external stakeholders. The BH Population Health Manager reports directly to the Vice President of Clinical Quality Improvement and Population Health. This position will provide key leadership and oversight for the development, management, continuous improvement and coordination of a network of behavioral healthcare service providers under contract with our health plan. The BH PH Manager will collaborate with the Senior BH Transformation Strategist and other key departments to coordinate operational integration and alignment of behavioral health services with internal departments and external behavioral health provider network. Promote network development to ensure behavioral health capacity including integrated physical and behavioral health; outpatient and specialty mental health; and other BH services.

Essential Responsibilities:

• Accountable for supporting compliance to federal and state regulatory requirements related to behavioral health in each CCO.
• Accountable for aligning BH Population Health Team to ensure implementation of a multi-year behavioral health (BH) transformation/improvement strategy focused on integrated, outpatient, specialty and residential behavioral health along integrated physical and behavioral health with external stakeholders.
• Work with provider partners along with County and State to improve integration of physical health, behavioral health, and dental health that ensures comprehensive management and compliance of behavioral health services for PacificSource members. These functions include, but are not limited to: Organizational development and community partnership; policy and contracting development with various stake holders, including state, community, facility and individual providers; Coordination and delivery of behavioral health services.; and
• Consideration of physical, psychological, and cultural factors.
• Responsible for developing the BH Pop Health Team including hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
• Demonstrates analytical skills and ability to successfully collaborate with analytics to develop dashboards and tools to communicate performance and improvement opportunities for clinics in integrated system of care in primary and specialty behavioral health.
• Actively participates in various internal and external committees in order to provide behavioral health expertise, disseminate information, and promote BH Transformation and Improvement Plan.
• Participates in the development, implementation and review of behavioral health policy, procedures and other guidelines as needed.
• Coordinates with Sr. Behavior Health Transformation Strategist to understand and deploy needed BH clinical strategies as dictated by evidence-based criteria, legislation and parity needs.
• Will work closely with the BH Medical Director (via matrix reporting) as to implementing the vision and policy for BH services, especially those around integration of BH and medical.
• Demonstrates strong communication skills (verbal and written) to ensure effective and successful relationships and follow through.
• Utilize lean methodologies to identify process improvement and cultivate a culture of continuous improvement.
• Support BH contract development and negotiations for BH providers/entities as needed.
• Ensure strong collaboration between Population Health, Quality Improvement, and Care Management teams with external provider partners to enhance care coordination and drive best outcomes for our members.
• Support annual department budgets including development and ongoing monitoring throughout the year and take corrective action where needed.

Supporting Responsibilities:

• Act as an internal resource by answering questions requiring behavioral health or contract interpretation that are referred from other departments, as well as physicians and providers of behavioral health services.
• Work with department leadership in responding to inquiries or complaints to the Insurance Commission, preparing reports for other review functions, and addressing grievances and appeals.
• Coordinate business activities by maintaining collaborative partnerships with key departments.
• Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy. Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Work Experience:

A minimum of five years clinical behavioral health experience with varied health care exposure and experience. Demonstrated knowledge and experience with personnel management; program development and management; contracting and oversight in a publicly-funded environment.

Education, Certificates, Licenses:

Bachelors' degree required or equivalent years of experience required. Master's level in Health care or another relevant field preferred and/or registered nurse or clinical social worker license preferred.

Knowledge:

Thorough knowledge and understanding of behavioral health best practices, diagnoses, treatment modalities, procedure codes, including ICD- 10, DSM V, and CPT Codes, health insurance and State of Oregon mandated benefits. Thorough knowledge of community services, providers, vendors and facilities available to assist members. Ability to use computerized systems for data and document recording and retrieval. Maintain current clinical knowledge base. Proficient in the use and implementation of the following tools and concepts across all teams within scope of accountability: Training, Strategy Deployment, Daily Operations, Visual Management, Operational Improvement, and Team Building and Development.

Competencies:

Building Trust

Building a Successful Team

Aligning Performance for Success

Building Partnerships

Customer Focus

Continuous Improvement

Decision Making

Facilitating Change

Leveraging Diversity

Driving for Results

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25% of the time.

Skills:
Accountable leadership, Collaboration, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic Thinking

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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