Behavioral Health Vendor Relations Manager - Hybrid

About us:

Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

The Behavioral Health Vendor Relations Manager serves as the primary liaison between Fallon Health and its contracted behavioral health vendor. This role ensures seamless contract execution, operational excellence, and financial oversight across all lines of business. The Manager drives strategic partnerships, leads cross-functional initiatives, and promotes behavioral health integration to improve member outcomes and vendor performance.

Vendor Management

Lead weekly vendor account meetings to address operational needs and resolve issues.
• Manage behavioral health provider contracts and maintain accurate documentation.
• Develop and maintain vendor scorecards and performance metrics.
• Identify and implement process improvements for vendor management.
• Escalate and troubleshoot vendor-related issues promptly

Delegation Oversight & Reporting

• Manage and oversee the reporting package provided by the behavioral health vendor, ensuring timely and accurate submission of all required reports.
• Monitor and verify that the vendor consistently meets all compliance, regulatory, and contractual obligations as outlined in agreements.
• Collaborate with the vendor and organizational leadership to proactively identify areas of concern or non-compliance, and address these through structured discussions during weekly account meetings.
• Lead weekly vendor account meetings to address operational needs, resolve issues, and review reporting outcomes.
• Develop and maintain vendor scorecards and performance metrics, using data from reporting packages to drive accountability and performance improvements.
• Identify and implement process improvements for vendor management, with a focus on compliance and reporting accuracy.
• Escalate and troubleshoot vendor-related issues promptly, ensuring transparency and alignment with organizational standards.

Cross-Functional Collaboration

• Serve as department lead on cross-functional teams and subcommittees.
• Coordinate with internal departments (Care Services, Claims, Credentialing, IT, Finance).Promote behavioral health integration across Fallon Health and partner organizations.
• Communicate vendor updates and coordinate solutions across teams.

Provider Relations Management

• Troubleshoot financial issues related to vendor and provider contracts.
• Collaborate with vendors to strengthen strategic partnerships with behavioral health providers.

Education:

Bachelor's degree required. Master's degree in Healthcare Administration, MBA, MPP, MPH or similar preferred, but not required.

License:

License or Certification in behavioral health (e.g., CADC), or as a behavioral health professional (e.g., LMHC, LCSW, LICSW, LADC etc.) is required. Valid Massachusetts Driver's License.

Experience:

• Minimum 3 years in a managerial role overseeing programs, vendors, or operations, preferably in managed healthcare or public sector programs.
• Knowledge of Medicare and Medicaid reimbursement, behavioral health coding and billing, and state contracts.
• Familiarity with the continuum of care for SUD and BH services in Massachusetts.
• Experience with behavioral health integration, alternative payment models, and innovative care delivery strategies.
• Strong analytical, strategic thinking, and problem-solving skills.
• Excellent communication skills (verbal, written, electronic).
• Proficiency in Microsoft Word, Excel, PowerPoint, Project, Planner, and other MS Office tools.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $100,000 - $115,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate's experience, skills, and fit with the role's responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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