Job Description: Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Position Overview: Responsible for successful execution, coordination and support of PacificSource's clinical initiatives. Key areas of focus include oversight and management of provider performance on clinical quality, risk assessment, care management and coordination of collaborative efforts related to patient and member health outcomes. Collaboration with targeted provider groups to guide and develop practice specific strategies designed to optimize clinical outcomes and accurate documentation of behavioral health chronic conditions. This position will work directly with internal PacificSource departments to build/strengthen relationships with strategic provider partners; ensure effective education, reporting and proactively identify improvement opportunities that support PacificSource's strategic goals.
Contribute to the development and execution of organization wide provider campaigns focused on improving clinical outcomes and alignment with PacificSource strategic goals.
Identify and facilitate implementation of evidence-based practices and interventions to help providers improve care outcomes and decrease costs.
Work with stakeholders to develop improvement action plans and strategies based on performance analysis to achieve specific outcomes.
Develop and implement strategies that further the integration of primary care and behavioral health, and increase communication between primary care and specialty behavioral health providers.
Assure specialty behavioral health services that are based on fidelity models are accessible to members and meet relevant regulatory requirements designed to achieve the highest possible outcomes.
Identify and monitor metrics to ensure progress aligns with shared goals. Evaluate need for mitigation strategies as barriers arise.
Create and/or distribute shared business plans and monitoring documents to support shared goals; including charts, graphs and analytics related to key performance metrics.
Provide ongoing training, coaching and high touch support to network providers and clinic staff toward the development and implementation of improvement initiatives to drive gap closure, member experience, appropriate documentation, and care outcomes within their own practices.
Establish credible, consultative relationships with network physicians and clinic staff to unite PacificSource internal resources with provider groups to ensure coordinate efforts and decrease member abrasion.
Work closely with internal departments to share provider feedback and proactively facilitate issue resolution.
Collaborate with Risk Assessment and Provider Network departments to develop and deploy aligned quality performance programs to drive better provider satisfaction and quality outcomes.
Maintains a detailed understanding of all shared data elements, the systems necessary to support actionable interventions/review and drives internal initiatives designed to improve the collection and reporting of supplemental data.
Evaluate provider-related programs, initiatives and interventions to determine the effectiveness of activities and make recommendations to improve outcomes.
Coordinate and lead cross functional teams to support critical engagement activities and to achieve performance targets.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: At least five years of experience in behavioral health care with a strong clinical focus. Experience in quality improvement, practice and systems facilitation, and program development.
Education, Certificates, Licenses: Master's degree required in counseling, psychology, social work, or related field. License in behavioral health related field preferred.
Knowledge: Knowledge of State of Oregon Medicaid regulations, mandated benefits and systems of care for behavioral health. Thorough knowledge and understanding of the needs of the SPMI population, Substance Use Disorders, youth and adult developmental stages, effective treatment modalities and relevant procedure codes. Ability to develop, review, and evaluate utilization reports. Knowledge of quality improvement methodology. Experience giving presentations. Organizational skills with solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Ability to work independently with minimal supervision.
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.