Plans, coordinates and manages overall behavioral health services in a dedicated WellCare region, including provider identification, negotiation, contracting and service functions. Responsible for overseeing regulatory compliance with laws, regulations and policies that govern behavioral health aspects of Medicaid and Medicare business. Acts as the behavioral health leadership representative for the region assuring customer service, provider and government relations and that operations goals and objectives are achieved. Assignments are broad in nature, usually requiring considerable creativity, originality and ingenuity.
DEPARTMENT: Health Services
REPORTS TO: VP, Field Health Services
- Negotiates and contracts with mental health and substance abuse providers to meet network requirements, identifies network expansion opportunities and services providers.
- Assists in establishing effective operational practices and works closely with various health plan departments and regulatory agencies to ensure contracts meet operating, financial and legal standards.
- Performs data analysis and develops specific actions to manage medical cost trends.
- Assists in developing practices to assist risk partners in managing financial risk.
- Directs area activity to ensure compliance with all regulatory and organizational requirements and standards.
- Identifies areas to improve provider and member service levels within operating budget parameters.
- Educates and enhances relationships within the provider community, including community mental health centers, hospitals and individual providers and groups.
- Manages resources to meet operational goals and budgets, coordinating with services provided in Tampa, FL.
- Coordinates closely with the regional health plan(s) in meeting service objectives and community needs.
- Implements corporate and area initiatives to achieve optimum results.
- Identifies and assesses opportunities to improve HBH results, communications and operating efficiencies.
- Provides technical direction to team associates, other directors and management.
- Participates in HBH and health plan operational meetings.
- Perform all other related duties as assigned by the COO.
Education and Experience:
- Bachelors level education or equivalent directly related experience
- 7-10 years of progressively responsible managerial experience
- Strong functional and technical knowledge of healthcare delivery
- 5 years of behavioral health management experience, particularly in the areas of provider and network management and operations
- Demonstrated people management and facilitative skills
- Excellent interpersonal skills and demonstrated ability to influence internal and external constituents
- Proven analytical skills and financial skills
Communication and Numeric Skills:
- Verbal and written communication skills sufficient to communicate clearly and grammatically both complex and simple messages to a wide audience either within or outside of the organization.
- Knowledge of Microsoft Outlook sufficient to communicate with both internal and external contacts.
- Knowledge of Microsoft Word and Excel sufficient to enter data, create tables, calculate mathematical and statistical formulas, copy or cut and paste data and print results as required.
- Experience with Microsoft Access preferred.
- Knowledge of or ability to learn Diamond, CRMS and other company software applications.