Position: Director, Behavioral Health Network & Market Strategy (Medicaid)
* The Director, Behavioral Health (BH) Network and Market Strategy will insure that the appropriate providers are engaged and recommend clinical models based on specific behavioral health market needs. Conducting new market evaluation, RFP development and implementation. This position will work cross functionally with business development teams and provider contracting.
* + Leads strategy for advance market intelligence to improve RFP responses and implementation efforts
+ Assesses Medicaid BH provider network needs for each market (services, provider/facility types, network adequacy), supports geographical analysis of member access to care gaps.
+ Support BH provider recruitment for new business and expansions
+ Support provider contract review and onboarding
+ Assesses local value-based care opportunities, supports value based provider recruitment/ contracting
+ Supports the development of VBC models – payment model design (full or partial risk, PPPM, upside only, shared savings, performance/outcomes-based contracting etc.). Supports the conceptual framework for measuring VBP program outcomes.
+ Identifies provider integration contracting opportunities (FQHCs, PCP/BH, BH Integrated Health Homes, rural health clinics)
+ Researches new market BH systems of care and identifies gaps in care/services
+ Development of network and provider relations training strategy
+ Works closely with operational and Clinical leaders within Medicaid and across the organization
+ Researches and recommends clinical models that address the needs of various sub-populations of membership (youth suicide, Trauma, chronically mentally ill and SUD adolescents/adults, etc.)
* + Bachelor’s degree
+ 3 years Network and provider relations experience
+ 8 s of progressive work experience in the health insurance industry
+ 5 s of management experience in a Medicaid managed care environment
+ 3 s of behavioral health experience
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
+ If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
* + Master’s Degree
** Additional Information*
* This position will report to the VP, Medicaid Behavioral Health, and will have approximately 4-6 Direct reports
** Scheduled Weekly Hours*