Behavioral health case manager serp_jobs.h1.location_city

Contracting Leader And Subject Matter Expert

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities :

• Telecommute position. Ideal person will reside in Washington State
• Some minor travel throughout Washington State will be required
• Serve as contracting leader and subject matter expert for Washington State Medicaid, Medicare and commercial outpatient and facility behavioral health provider / group / agency / facility contracting (amendments and contract maintenance) and any other state assigned; this includes end-to-end contracting processes for new programs and products and serving as a contracting subject matter expert
• Serve as contract leader and subject matter expert in one or more other states too for Medicaid, Medicare and commercial outpatient and facility behavioral health provider / group / agency contracting - Solid preference for candidates with experience with Medicaid in Arizona and California and knowledge of behavioral health contracting markets and geography in Arizona, California, Oregon and Western U.S
• Regular interface and leadership role with UHC health plan leadership, internal behavioral health functional leadership including finance and underwriting, provider leadership, and state regulators
• Work with behavioral health economics, finance and underwriting in development, maintenance and monitoring of provider payment arrangements
• Presents and reports verbally and in writing to state regulators (examples in WA State include Health Care Authority, Department of Human Services, Department of Health, Department of Commerce) via conference calls about Medicaid contracting, provider contracting, network adequacy, recruitment development and related topics
• Meets with, presents to, and negotiates on behalf of Medicaid Health Plan with Behavioral Health - Administrative Service Organizations (BH-ASOs) regarding reimbursement, service, delegation or other revisions to Crisis Administrative Service Agreement and delegation and related exhibits
• Develops new, unique base behavioral health (outpatient and facility) contract templates, statements of work and payment appendices for Washington Medicaid programs for discussion, review and approval within organization and eventual submission for approval by WA Office of Insurance Commission and WA Health Care Authority
• Understands standard behavioral health provider reimbursement, such as fee for service and per diem. Has working knowledge of behavioral health CPT codes and Washington State SERI (Service Encounter Reporting Instructions)
• Understands alternative reimbursement methods used for Washington Medicaid including Population-Based Payment, Capitation, Case Rates, and Per Member Per Month (PMPM)
• Uses higher-level discernment and decision-making abilities that enable someone to support and work with upper level-management and state regulators
• When interacting with providers, manages clear provider expectations about timelines for contracting, credentialing, reimbursement levels and methodology, site audits, and the like
• Develops and maintains primary network contracting relationships with external (e.g., behavioral health providers, behavioral health groups, behavioral health agencies / community mental health agencies / federally qualified health clinics, facilities, tribal government and other tribal organizations, government agencies) and internal customers; these relationships will be positive and productive
• Issues provider applications, agreements and related documents to providers
• Gathers completed provider applications and other documents that accompany the application, other documents required by state law and / or company policy; review these documents for completeness, accuracy, organize, and submit documents for credentialing
• Assembles provider agreements consisting of base agreements, appendices and addendums, fee schedules and related documents
• Coordinates and follows-up with provider relations advocates to ensure timeliness of submission of applications and related documents
• Is continually engaged; promptly responds to external and internal customer inquiries; responsible for remaining engaged with external and internal customers until tasks are complete; responsible for proactively keep external and internal customers updated about status of requests; communicates with external and internal customers via phone and email and using each appropriately to develop solid working relationships, this includes being prepared for scheduled calls with customers and writing professional communications
• Understands our provider contracts and contract language, terms and conditions and occasionally review provider's proposed language changes and occasionally draft counter language for review by supervisor and legal counsel)
• Models : personal responsibility, dependability, reliability and flexibility in being able to meet the needs of the team and business; accepts responsibility and accountability for actions; continually learns and retains / absorbs knowledge, information and skills to perform the position as you work independently
• Models integrity and honesty; behaves in an honest, fair, and ethical manner; if says work is complete, it truly is complete and accurate according to standards. Takes the "higher road" when it comes to conflict
• Models stewardship of recourse and documents; is efficient and effective with use of work time; archives and saves fully executed agreements, current fee schedules and related documents in appropriate locations; responsible with public (Medicaid and Medicare) and private funds when negotiating reimbursement in provider agreements
• Reports to the Director of Outpatient Behavioral Health Contracting of the Western U.S.; Keep Director updated on timely basis about provider network development, contracting developments, rate negotiations, rate increase requests, emerging issues and the like; actively participates in Western U.S. Outpatient Behavioral Health Contracting Team Meetings and collaborates with peers
• Use proprietary and other software programs for sending, updating and storage of provider / agency / group / facility contracts and numerous fee schedules and related contractual documents
• Develops, updates and maintains numerous fee schedules
• Actively participates in scheduled and ad hoc joint Provider Relations - Outpatient Behavioral Health Contracting Meetings to ensure continuity of communication and coordination between; proactively copies provider relations colleagues on provider communications to keep them in the loop about provider communications
• Actively participates on a regular basis with a variety of internal meetings with various functional areas including but not limited to provider services / provider relations, network strategy, legal, other contracting teams, project managers, health care economics, finance, underwriting, clinical, clinical operations, compliance, claims, consumer affairs, information technology, and sales
• Communicates throughout each workday via emails and phone communication with internal and external customers
• Works in a fast-paced work environment with multiple competing priorities
• Required to work office hours of 8 : 00 am to 5 : 00 pm PST as a telecommuter in order to respond to internal and external customers; this is a salaried position and will require more than 40 hours per week at times to keep up with work or complete work assignments
• Light travel required on occasion within the market during provider recruitments and / or meet with important / high profile providers

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications :