Regulatory Manager, Behavioral Health - Boston, United States - Partners , Inc.
Description
:This is a full-time (40 hour/week), remote role that can be done in most US states. Infrequent travel (every other month) to the office in Somerville for meetings is encouraged
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry.
As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems.
Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees.Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
Mass General Brigham Health Plan provides for the delivery of behavioral health services to its members through a contracted relationship with United Behavioral Health (Optum), a managed behavioral healthcare organization.
The Director of Behavioral Health provides oversight of its behavioral health vendor and is responsible for ensuring that services for Mass General Brigham Health Plan members are accessible, available, integrated, and coordinated with primary care.
The Director of Behavioral Health works with internal and external stakeholders (i.e., Mass General Brigham, Commercial employer groups, EOHHS, MassHealth Office of Behavioral Health, CMS, and Trade Organizations) to ensure that the benefits and continuum of care meet the needs of the Mass General Brigham Health Plan's membership.
The Regulatory Manager, Behavioral Health (BH) position is a part-time, 24-hours-per-week position and will assist the Director of BH in the development and implementation of policies and procedures that measure the adherence of the health plan's BH clinical programs to key stakeholders, such as our key commercial accounts, as well as state and federal funding agencies responsible for funding and overseeing Medicaid and Medicare plans.
This will include but is not limited to, setting up monitoring and adherence protocols that CMS requires for Medicare Advantage clinical programs, as well as identifying, developing, and executing all audit and mental health parity requirements as set for by the Executive Office of Health and Human Services for any Medicaid Accountable Care Organization.
The Regulatory Manager, BH will identify barriers and leverage strengths throughout the company to ensure the Mass General Brigham Health Plan BH clinical programs meet or exceed all state and federal requirements and will act as a subject matter expert on such topics as mental health parity, clinical audit programs, and the interpretation of rules and regulations both at the state and federal level.
This person will collaborate with the legal, regulatory affairs and compliance department very closely to ensure the programs are socialized and vetted at the appropriate committees, including but limited to the Mass General Brigham Health Plan Audit and Compliance Committee, and Standards, Expectations and Compliance Committee.
Principal Duties and Responsibilities:
Act as a subject matter expert in mental health parity, which will include, having a strong understanding of the current state and federal laws, as well as best practices that can address and close any mental health parity gaps.
Provide expertise in the area mental health parity and provide language and/or operational recommendations that will reduce mental health parity and put MGB HP 'best in class' in this area.
Provider leadership and consultation in mental health parity to colleagues, as well as key internal and external stakeholders at the state and federal level.
Work closely with the legal, regulatory affairs, and compliance department to ensure all clinical programs are up to date and compliant with current regulations and laws.
Maintain compliance with all BH utilization management and audit standards, including, but not limited, to the ongoing assessment of program performance against regulatory and business standards, and removal of barriers which may impede the plan's ability to meet those standards.
Prepare for any site visits by state or federal agencies, which will include the compilation of materials, education to clinical staff, addressing any areas of non-compliance, and the solutions aimed at removing areas of oversight of any under or over utilization of services as well as expertise on the ways in which to adjust utilization of services to an accepted level.
Provide oversight of any under or over utilization of services as well as expertise on the ways in which to adjust utilization of services to an accepted level.
Act as a subject matter expert to senior and executive staff in the areas of audit protocols and how they can be leveraged through the company to better understand and manage services.
Coordinate required and ad hoc submissions to a wide vary of stakeholders, including but not limited to, the Executive Office of Health and Human Services, Massachusetts Department of Insurance, Center for Medicaid and Medicare Services, Massachusetts Association of Health Plans, the Massachusetts Center for Health Information and Analysis.
Oversee audit protocols that assess the denial processes and practices and develop management and reporting tools that are helpful and impactful to the department.
Oversee any BH utilization management or care management delegation agreements with outside providers, as well as internal stakeholders within Mass General Brigham.
This will include coordinating with other areas within Clinical, such as quality management, and recommending practices that adhere to key programs such as National Committee for Quality Assurance health plan accreditation and health equity accreditation.
Advise and recommend strategy, approach, and language regarding any delegation agreements with the MGB HP clinical program and other internal/external parties.
Qualifications:
Qualifications:
Master's degree required or the equivalent combination of training and experience, plus 8-10 years of related experience in health care/managed care, Medicare Advantage experience, community health nursing, public health background.
Skills/Abilities/Competencies:
Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills.
Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
EEO Statement
Mass General Brigham is an Equal Opportunity Employer.
By embracing diverse skills, perspectives and ideas, we choose to lead.
All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.
We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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