QM BH Provider Liaison (LMSW, LPN, LMHC, LCSW, RN)

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Quality Management Behavioral Health Provider Liaison (BHPL) serves as the primary partner for Behavioral Health providers to improve performance in key HEDIS/QARR metrics. The BHPL is a strategically oriented professional who helps lead provider engagement, with a focus on leveraging data available to providers, and improve the value delivered to MetroPlusHealth members. The BHPL achieves this by building highly collaborative and strategic partnerships and bringing an analytic mindset to discussion with providers. The successful candidate will build relationships with internal teams, coordinate with clinical and quality departments, and achieve HEDIS/QARR performance. The BHPL drives provider performance improvement year-over-year through education, establishment of best practices, use data driven interventions and ensure data integrity/completeness. The BHPL will train practices how to utilize available tools to improve care for members with Behavioral Health conditions, implement population health strategies, understand how their practice is performing on Key Performance Indicators and other health outcome measures, and properly code/document for HEDIS/QARR events.

• Partner with contracted inpatient/outpatient Mental Health and Rehab/Detox facilities to provide support to Behavioral Health Providers through face-to-face, virtual and telephonic meetings. These strategic partnerships will be designed to increase provider knowledge of behavioral health HEDIS/QARR measures, provide supporting performance data and goals, and establish linkages between inpatient and outpatient behavioral health providers.
• Communicate provider data needs back to the organization to ensure end-to-end partnership.
• Review present state provider coding/documentation practices and educate on proper claims submission protocols.
• Create new data streams to ensure high data integrity/completeness for HEDIS/QARR submissions.
• Educate providers on medication and treatment compliance and promote the use of Long Acting Injectables and Medication Assisted Treatment.
• Communicate complex data in a way that is easy to understand.
• Partner with network providers to assess current state and operationalize innovative programs and strategies to improve clinical and quality outcomes.
• Lead the development of root cause analysis, interventions, project planning, tracking and outcome summary reports for specific behavioral health measures.
• Monitor and analyze interventions to ensure goals, objectives, outcomes are met.
• Monitor for adverse measure trends, recommend modifications and corrective actions.
• Develop data collection mechanisms to track performance.
• Conduct initial measure research and quality intervention development for new NCQA/state BH measures.
• Assist in ad-hoc projectsthat serve to educate and build provider awareness of behavioral health aspects of care including, but not limited to, outreach to increase screenings and referrals by PCPs, build awareness around CORE and BH HCBS services and other state and plan initiatives that require provider education.
• Contribute to the identification of best practices across the entire group of PQMs nationally and integrate high-quality program ideas/designs into the local market to drive high levels of value.
• Ability to travel within local New York City market on a regular basis to meet with high volume providers/provider groups.
• Organize data and create presentations that are effective in assisting providers with performance improvement.
• Develop methods and/or tools to collect and track barriers for targeted members and providers.
• Develop/deliver member and provider communications that are clear, direct, and actionable.
• Consistently applies PDSA methodology to all quality improvement work.
• Responsible for keeping professional license current

• Bachelor's degree in a clinical field required. Advanced degree preferred.
• Must have a minimum of 5 years' experience in the health care field, preferably with a managed care organization.
• Previous experience in a large inpatient behavioral health setting.
• Demonstrated ability to communicate effectively, problem solve and work effectively with people.
• Working knowledge of Medical/Behavioral Health terminology including diagnosis, medications, and levels of care. Working knowledge of HEDIS/QARR.
• Must be proficient in Microsoft Word, PowerPoint, Excel and Access.
• Experience with and proficient in data analysis. Working knowledge of relational database and statistical analyses is a plus.
• Must have in-depth knowledge of PDSA methodology and its application and is familiar with and have a working knowledge with QI process improvement methodology strategies including but not limited to DMAIC.
• Must be confident, autonomous, solution driven, proactive and detail oriented. Must possess high standards of excellence, diplomacy, resourcefulness, and strong intuition.
• High quality of interpersonal/team skills.
• Understanding of patient confidentiality.
• Ability to work in a fast-paced environment.
• Excellent time management and organizational skills.
• Ability to prioritize and manage changing priorities under pressure
• Current licensed RN (Psych preferred), LPN, LMHC, or LMSW/LCSW
• Six Sigma Yellow or Green Belt preferred.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical/Analytical Skills
• Teamwork
• Written/Oral Communications

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