Director Behavioral Health Network amp Market Strategy Medicaid

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Job Information

Humana

Director, Behavioral Health Network & Market Strategy (Medicaid)

in

Lancaster

South Carolina

Description

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.

Responsibilities

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.)

Required Qualifications:

Bachelor's degree

3 years Network and provider relations experience

8 or more years of progressive work experience in the health insurance industry

5 or more years of management experience in a Medicaid managed care environment

3 or more years 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.

Preferred Qualifications:

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

40

Company info

Humana Inc.
Website : http://www.humana.com