Director, Behavioral Health Provider Network
Apply NowCompany: InnovAge
Location: Denver, CO 80219
Description:
Responsibilities
Under the direction of the SVP Provider Strategy and Network Management, this role manages the development and sustainability of the affiliate behavioral health provider network. Responsible for sourcing and the introduction of InnovAge PACE to the provider community. Works in collaboration with primary care, behavioral health clinical, and operations leadership to identify and contract with community behavioral health affiliate providers to meet the complex needs of the InnovAge PACE participants. This position will collaborate with the InnovAge legal team to coordinate contracting and credentialing activities. The Director, Behavioral Health Provider Network is responsible for contracting, provider education, and provider relations support of all behavioral health providers to include inpatient and outpatient clinical and support services and interventional supports. In addition, the Director, Behavioral Health Provider Network provides provider and operational support to ensure compliance with contracted terms, access, and availability.
Essential Functions and Work Responsibilities
Functional Category: Provider Network Management
Estimated Percent of time Spent - 100%
Responsible for identifying provider targets initiating/finalizing provider contracts through the InnovAge contracting process.
Supports the Network team as the behavioral health subject matter expert when applicable for large health systems and multi-specialty group practices and organizations.
Build and develop strong face to face and virtual relationships within the provider community to ensure that effective partnerships are in place to meet the needs of the organization and its participants.
Works in collaboration with the Primary Care Team, Behavioral Health clinical, and the Interdisciplinary Teams to identify gaps in the behavioral health provider network.
Responsible for conducting provider in-services and educating network providers on the InnovAge PACE model of care and processes.
Responsible for utilizing InnovAge PACE approved materials that are in compliance with state, CMS and any other regulatory agency.
Responsible for communicating and updating providers on any changes in practice or process in collaboration with the Interdisciplinary Team and the department SVP.
Conducts face to face provider service visits.
Provide the department SVP with their strategy approach to close access to care gaps through analysis of the behavioral health provider network's effectiveness and accessibility.
Under the direction of the SVP Provider Strategy and Network Management assist in addressing provider related issues including but not limited to provider and participant grievance and appeals, claims, communication barriers and any other related provider relation concerns in a timely and a professional manner.
Travel Requirements
Travel
Travel required
Overnight travel out of state
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
REQUIRED
Education
Bachelor's degree from an accredited college or university in an appropriate discipline; e.g., Business, Healthcare Administration, Public Health
Work Experience and Qualifications
A minimum of 8 years' experience with network development and management.
Complex contracting and provider relations experience is required.
Experience directing provider network contracting, process and service is essential.
Experience with managed care contracting and provider relations
Previous experience with Medicare and Medicaid is preferred
Other Knowledge Skills and Abilities Required
Computer Skills
Must be computer proficient and possess experience with Microsoft Word, Excel, and Outlook and other Office products.
Must be able to quickly learn specific software and new applications.
Mathematical/Financial Skills
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Able to analyze data and statistics and draw reasonable conclusions and compile accurate reports.
Experience with P/L and developing and managing medical cost initiatives.
Language Skills
Ability to read, analyze and interpret regulations and other documents.
Strong interpersonal skills and ability to effectively and tactfully present information to, and communicate with, co-workers, employees, and others.
Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge.
Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.
Reasoning Ability
Ability to define problems, collects data, establish facts, and draw valid conclusions.
Intense intellectual curiosity and ability to view old problems with a fresh perspective
Other Skills and Abilities:
Exceptional critical thinking ability to effectively adapt to changing business needs and manage uncertainty and competing priorities
Comfortable with ambiguity; working for an evolving organization where there isn't always clarity about what should be done next; must solved thorough coordination with the broader organization and deploy consistent solutions across all markets.
Effective at influencing others to achieve objectives even when not in their direct control
Able to establish and maintain cooperative, positive working relationships.
Organized, detail-oriented, good listening skills, proactive, self motivated, dependable, and trustworthy.
Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.
Excellent management ability combined with the skills to effectively represent the program to participants, families, outside agencies, community groups and the general public.
Knowledge of utilization review, quality assurance and managed health care concepts
Benefits
InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.
InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.
Applicants are considered until the position is filled.
Posted Salary Range
USD $136,440.00 - USD $177,380.00 /Yr.
Under the direction of the SVP Provider Strategy and Network Management, this role manages the development and sustainability of the affiliate behavioral health provider network. Responsible for sourcing and the introduction of InnovAge PACE to the provider community. Works in collaboration with primary care, behavioral health clinical, and operations leadership to identify and contract with community behavioral health affiliate providers to meet the complex needs of the InnovAge PACE participants. This position will collaborate with the InnovAge legal team to coordinate contracting and credentialing activities. The Director, Behavioral Health Provider Network is responsible for contracting, provider education, and provider relations support of all behavioral health providers to include inpatient and outpatient clinical and support services and interventional supports. In addition, the Director, Behavioral Health Provider Network provides provider and operational support to ensure compliance with contracted terms, access, and availability.
Essential Functions and Work Responsibilities
Functional Category: Provider Network Management
Estimated Percent of time Spent - 100%
Responsible for identifying provider targets initiating/finalizing provider contracts through the InnovAge contracting process.
Supports the Network team as the behavioral health subject matter expert when applicable for large health systems and multi-specialty group practices and organizations.
Build and develop strong face to face and virtual relationships within the provider community to ensure that effective partnerships are in place to meet the needs of the organization and its participants.
Works in collaboration with the Primary Care Team, Behavioral Health clinical, and the Interdisciplinary Teams to identify gaps in the behavioral health provider network.
Responsible for conducting provider in-services and educating network providers on the InnovAge PACE model of care and processes.
Responsible for utilizing InnovAge PACE approved materials that are in compliance with state, CMS and any other regulatory agency.
Responsible for communicating and updating providers on any changes in practice or process in collaboration with the Interdisciplinary Team and the department SVP.
Conducts face to face provider service visits.
Provide the department SVP with their strategy approach to close access to care gaps through analysis of the behavioral health provider network's effectiveness and accessibility.
Under the direction of the SVP Provider Strategy and Network Management assist in addressing provider related issues including but not limited to provider and participant grievance and appeals, claims, communication barriers and any other related provider relation concerns in a timely and a professional manner.
Travel Requirements
Travel
Travel required
Overnight travel out of state
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
REQUIRED
Education
Bachelor's degree from an accredited college or university in an appropriate discipline; e.g., Business, Healthcare Administration, Public Health
Work Experience and Qualifications
A minimum of 8 years' experience with network development and management.
Complex contracting and provider relations experience is required.
Experience directing provider network contracting, process and service is essential.
Experience with managed care contracting and provider relations
Previous experience with Medicare and Medicaid is preferred
Other Knowledge Skills and Abilities Required
Computer Skills
Must be computer proficient and possess experience with Microsoft Word, Excel, and Outlook and other Office products.
Must be able to quickly learn specific software and new applications.
Mathematical/Financial Skills
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Able to analyze data and statistics and draw reasonable conclusions and compile accurate reports.
Experience with P/L and developing and managing medical cost initiatives.
Language Skills
Ability to read, analyze and interpret regulations and other documents.
Strong interpersonal skills and ability to effectively and tactfully present information to, and communicate with, co-workers, employees, and others.
Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge.
Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.
Reasoning Ability
Ability to define problems, collects data, establish facts, and draw valid conclusions.
Intense intellectual curiosity and ability to view old problems with a fresh perspective
Other Skills and Abilities:
Exceptional critical thinking ability to effectively adapt to changing business needs and manage uncertainty and competing priorities
Comfortable with ambiguity; working for an evolving organization where there isn't always clarity about what should be done next; must solved thorough coordination with the broader organization and deploy consistent solutions across all markets.
Effective at influencing others to achieve objectives even when not in their direct control
Able to establish and maintain cooperative, positive working relationships.
Organized, detail-oriented, good listening skills, proactive, self motivated, dependable, and trustworthy.
Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.
Excellent management ability combined with the skills to effectively represent the program to participants, families, outside agencies, community groups and the general public.
Knowledge of utilization review, quality assurance and managed health care concepts
Benefits
InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.
InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.
Applicants are considered until the position is filled.
Posted Salary Range
USD $136,440.00 - USD $177,380.00 /Yr.