"Alerted.org

011230 CA-Provider Engagement & Performance

Position Summary:

The Behavioral Health (BH) Provider Engagement Program Manager is responsible for cultivating strong, collaborative relationships with behavioral health providers and driving performance improvement through data insights, education, and partnership. This individual will serve as the primary point of contact for BH providers, promoting alignment with CCA’s mission and supporting high-quality, coordinated care for members.

In this role, the Program Manager acts as an account manager, relationship manager, and performance partner — using data, provider feedback, and system collaboration to enhance provider engagement, improve outcomes, and strengthen community-based partnerships. This position works closely with CCA’s Behavioral Health, Health Home, Network, and Clinical teams to ensure a seamless provider experience and consistent delivery of quality care.

The BH Provider Engagement Program Manager reports to the Director of Delegation Partnerships and Provider Engagement.

Supervision Exercised:

• No, this position does not have direct reports.

Essential Duties & Responsibilities:

Provider Relationship Management

• Serve as the primary relationship manager and point of contact for assigned BH providers, fostering collaboration and problem-solving.

• Represent CCA’s behavioral health priorities, programs, and initiatives to the provider network.

• Promote provider understanding of CCA’s mission, value-based approach, and expectations for quality, utilization, and member experience.

• Address provider inquiries related to care coordination, utilization management, and program participation, collaborating with internal teams as needed.

Performance and Data Insight

• Analyze and interpret provider data related to utilization, cost, quality, and outcomes to identify performance trends and opportunities for improvement.

• Develop and share actionable performance reports with providers to support data-driven quality improvement.

• Collaborate with internal analytics and clinical teams to ensure data insights are accurate, meaningful, and aligned with organizational priorities.

• Track provider progress on performance metrics (e.g., HEDIS, readmissions, community tenure) and follow up to support improvement efforts.

Program and Partnership Support

• Partner with the Health Home and Clinical teams to support consistency and quality across BH and Health Home providers.

• Participate in case review meetings and rounds as needed to enhance coordination and care transitions.

• Support the identification and implementation of innovative provider initiatives, pilots, and clinical improvement projects.

• Build linkages between levels of behavioral health care — from inpatient to community-based — to improve transitions and continuity of care.

Collaboration and Internal Coordination

• Work closely with the Network and Business Development teams to ensure information and insights are shared bidirectionally.

• Collaborate with cross-functional leaders, including community organizations, PCPs, and social service agencies, to strengthen relationships and community integration.

• Partner with the Behavioral Health leadership team to support initiatives related to value-based payment (VBP), quality improvement, and provider engagement.

Results and Accountability

• Manage assigned provider relationships and related projects to meet defined goals for engagement, quality, and performance.

• Develop and execute annual provider engagement plans informed by provider data, feedback, and CCA priorities.

• Follow through on performance improvement activities, monitoring impact and adjusting approach as needed.

Other Duties

• Support departmental projects and initiatives as assigned.

• Represent the Behavioral Health team in cross-functional meetings and external stakeholder discussions.

Working Conditions:

• This is a remote or hyrbrid role with the expectation of working according to Commonwealth Care Alliance’s standard operating hours of 8:30am-5pm Monday-Friday. Ability to travel to provider offices and access to reliable transportation.

Required Education (must have):

• Master’s degree in a behavioral health discipline (Psychology, Social Work, Counseling, or related field) or equivalent experience required.

Required Experience (must have):

• 5+ years

• Experience with Medicaid and Medicare products and programs

• Experience or knowledge of behavioral health services available to support dual eligible populations

• Experience in behavioral health clinical practice, provider relations, or healthcare management

Desired Experience (nice to have):

• Experience working with managed care organizations, value-based programs, or community-based behavioral health providers strongly preferred

• Experience with dual-eligible (SCO or One Care) populations preferred.

• Experience in healthcare program management, provider relations, or network management

• Knowledge of Massachusetts BH landscape

Required Knowledge, Skills & Abilities (must have):

• Strong relationship management and communication skills, with the ability to engage and influence diverse stakeholders.

• Demonstrated analytical ability to interpret and apply provider performance data.

• In-depth understanding of behavioral health systems, care delivery, and care coordination processes.

• Excellent organizational, time management, and project management skills.

• Ability to work collaboratively in a matrixed environment.

• Proficiency in Microsoft Office Suite; experience with data reporting tools preferred.

• Ability to function independently and effectively as part of an interdisciplinary team

• Strong and effective communication skills, both written and verbal

• Strong interpersonal and customer relations skills

• Effective teaching skills

• Mediation/facilitation/conflict resolution skills

• Demonstrates analytical skills necessary to review data

Required Language (must have):

• English

Desired Knowledge, Skills, Abilities & Language (nice to have):

• Proven skills, knowledge base, and judgment necessary for independent clinical decision making in alignment with clinical licensure.

• Strong understanding of Medicare, Medicaid (MassHealth), and dual-eligible program operations, including regulatory and compliance requirements.

• Demonstrated ability to describe and assess a simple business problem

• Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.