Provider Quality Manager
Company: Beacon Health Options
Location: Colorado Springs
Posted on: February 16, 2020
Beacon Health OptionsJob Category: Provider & Network -
GeneralReq #: MGRPR02174Schedule: Full TimeLocation: CO - Colorado
SpringsWe Help People Live their Lives to the Fullest
For more than 30 years, Beacon has changed the way people live with
behavioral health conditions. Today, we are the undisputed leader
in behavioral health management, serving 40 million people across
all 50 states. At Beacon, we are committed to delivering a
'world-class' candidate experience from the moment you click
'Apply'! Our goal is to help you reach your fullest potential,
while utilizing your talents and expertise to help us deliver on
Do you have a passion for helping others? If so, we are looking for
Beacon is currently seeking a Primary Care Provider Quality
Managers (PCPQM to join our team remotely for our Colorado
location. Primary Care Provider Quality Managers (PCPQM) are
strategically oriented professionals who help lead the next
generation of provider engagement, with a focus on leveraging the
data available to primary care providers, helping to improve the
value delivered to Beacon members. PCPQMs achieve this by building
highly collaborative strategic partnerships and bringing an
analytic mindset to discussions with providers. Building
relationships with internal Beacon teams will be necessary to be
successful in this role, in particular coordinating closely with
clinical and quality departments, to ensure high quality care to
members, and achievement of company HEDIS performance, as
applicable to the regional market. PCPQMs drive provider
performance improvement year-over-year through education and data.
PCPQMs train practices on how to utilize data to:
- Improve care for members with chronic conditions
- Implement population health strategies
- Understand how their practice is performing on Key Performance
Indicators and other health outcome measures
- Identify Members requiring Care Coordination
- Identify Members who require additional services
Data trends to be measured for improvement may include (but are not
- FUH, IET and other HEDIS outcomes
- Cost metrics
- Trends in length of stay
- Readmission Rates
- Community Tenure
- Access to medically necessary care
- Successful transitions of care
- Quality outcomes
- Key Performance Indicators
- Other utilization patterns and trends
What does a typical day look like?
- Provide support to Primary Care Providers through face to face
meetings, promoting integration of behavioral health and medical
care, with a spectrum of activities-from increasing knowledge of
behavioral health services and establishing linkages with
behavioral health providers, to establishing integration of
behavioral health services into primary care practices.
- Support Primary Care Providers in accessing care management
services for Beacon Members.
- Implement regionally based strategies that meet clinical,
quality, and network improvement goals through positive working
relationships with providers, state agencies, advocacy groups and
other market stakeholders.
- Interface with an assigned set of Primary Care Providers.
Meetings with providers are face to face, telephonic and via
Web-Ex. General parameters for type and frequency of meetings are
determined by the Regional Provider Quality Lead in collaboration
with other Regional and National leaders. Type and frequency of
meetings for specific providers are determined on a case by case
- Liaison for Beacon clinical, quality, Provider Strategy, and
network departments to ensure interdepartmental collaboration and
coordination of goals and priorities.
- Support regional and corporate initiatives regarding
Alternative Payment Models (APM), including Value Based Payment
(VBP), clinical innovation, and thought leadership transforming
provider relationships from transactional interactions to
collaborative aggregate data assessment.
- Liaison between assigned providers and Beacon Operations,
Claims and Provider Relations departments to support linkages for
issue resolution, helping to improve provider experience and
overall satisfaction with Beacon.
- Ensure, and create as necessary and as applicable depending on
the regional market, 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 Beacon stakeholders to
operationalize innovative programs and strategies to improve
clinical and quality outcomes.
- Analyze provider reports pertaining to cost, utilization, and
outcomes, and prepare this data to share with providers. Lead
analysis of data sets that identify data outliers and opportunities
for improvement for individual providers. Present data
strategically, detailing patterns and trends in provider
performance over time. Highlight key areas of focus, including
interpretation of provider utilization data that show patterns.
Ensure that data is kept meaningful to providers.
- Share data to help educate strategic providers about Beacon's
mission and vision, with a focus on driving high levels of value
for Beacon members and delivering on performance on behalf of
- Identify high-performing and innovative providers who may be
interested in new programmatic or payment models. Gather
information on program structure, function efficacy and outcomes to
share with Beacon colleagues. Work with those providers to
implement the new concepts. Communicate and collaborate with
regional leadership to support provider activities consistent with
Beacon's provider strategy and deliver progress to internal and
external stakeholders. 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. Help identify opportunities with regional and corporate
leadership for expansion and development of innovative pilot
programs, to include program development, implementation, launch,
and efficacy and outcomes measurements. Provider innovations should
reflect Beacon's thought leadership.
- Contribute to the identification of best practices across the
entire group of PQMs nationally and integrate high-quality program
ideas/designs into the local market to drive high levels of
- Provide consultation for clinically complex members.
- Surface clinical and quality issues to Beacon's regional
clinical and quality teams and participate in helping to address
- Work with Beacon clinical teams to be knowledgeable regarding
Beacon UM and care management programs and services, to be able to
answer or appropriately triage provider questions.
- 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; trainings and orientations will be led by Beacon's
network operations team.
- Closely collaborate with Beacon's network operations team to
ensure a fluid bi-directional sharing of information.
- Reliable transportation and ability to travel within local
market on a regular basis is required.
- Other duties and projects as assigned and specified by
supervisor in line with Department and company needs.
- 60% primary local travel
What you Contribute?
Education: BA required. Advanced degree in healthcare field
(nursing, behavioral health, public health highly preferred
License: Varies by state (RN, LCSW, LICSW, LMHC preferred
Knowledge, Skills & Abilities:
Knowledge of managed care, practice transformation, analytics,
performance improvement and clinical skill preferred. Strong
execution and follow-up skills, analytic skills, organization, and
ability to multi-task are key. 5-7 years of experience in a health
care setting, either provider or payer, required, primary care
preferred. Beacon anticipates the Provider Quality Manager will
spend time each week in four main ways
- Strategic Provider outreach and meetings (2 - 3 days/week)
- Analyze provider data to determine utilization and outcomes
outliers, including root cause analysis for outliers and
utilization patterns (1 day/week)
- Developing strategy for specific provider engagement activities
to be executed (1 day/week)
- PowerPoint report generation to prepare for on-site provider
outreach meetings (1/2 - 1 day/week)
- Support linkage for Provider-specific problem resolution and
navigation of Beacon by connecting providers to the appropriate
Beacon staff (1/2- 1 day/week)
What Makes Us Different?
- Here, it's not just a job - it's an opportunity to change
- Our employees are learners, innovators and original
- Our mission and values guide the way we treat our members,
providers and each other.
What We Have to Offer:
- Healthcare benefits available starting day 1!
- Health & wellbeing incentives, such as gym membership
- 401K with company match to help reach your future financial
- Generous PTO, because we know life happens outside of work
- Tuition reimbursement so you can keep reaching your fullest
If Beacon sounds like the place for you, what are you waiting for?
Apply with us today to get started!
Beacon Health Options is proud to be an Equal Opportunity and
Affirmative Action Employer as well as a Drug Free and Tobacco Free
Work Environment. EOE/AA/M/F/Veterans/Disabled
At Beacon Health Options, our candidate's data privacy is a top
priority. Our recruiting team conducts all communications using
official company email (@BeaconHealthOptions.com). Only candidates
who have applied for an open position through our Careers page
(careers.beaconhealthoptions.com) will be engaged in our interview
process. Beacon conducts all interviews in person or over the
phone. At no time during the recruiting process will any Beacon
recruiter request any financial or personally identifiable
information from you.
Keywords: Beacon Health Options, Colorado Springs , Provider Quality Manager, Executive , Colorado Springs, Colorado
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