Carelon Behavioral Health, Inc. is enthusiastically supporting the launch of the Statewide School-Based Fee Schedule project by the Department of Health Care Services (DHCS) as the dedicated Third-Party Administrator. Our goal? To improve the mental health services offered to California's young students via this pivotal initiative.

We're expanding our team and eager to connect with professionals experienced in healthcare administration, network management, provider credentialing and data analysis.

With this project, we're aligning our goals with Governor Newsom's Kids’ Mental Health and the Children and Youth Behavioral Health Initiative (CYBHI). We're working closely with DHCS, the Department of Managed Health Care (DMHC), and the California Department of Insurance (CDI) to implement a multi-payer fee schedule, ensuring fair reimbursement for school-linked providers offering designated outpatient mental health and substance use disorder services.

Provider Relationship Account Consultant (Behavioral Health) - CALIFORNIA

Location: This position will work a Hybrid model (remote and office). Ideal candidates must live in the state of California within 50 miles from one of our Elevance Health CA corporate offices. This position will travel to worksites and other locations as necessary.

*Seeking candidates that reside in either: Northern California, Bay Area, Central Coast or Southern California.

Work Shift: Monday thru Friday, 5 days a week during Pacific Standard Time business hours.

The Provider Relationship Account Consultant (Behavioral Health) is responsible for providing quality, accessible and comprehensive service to the company's provider community.

How you will make an impact:

• Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.

• Collaborates with internal matrix partners to triage issues and submit work requests.

• Generally assigned to a portfolio of providers within a defined cohort.

• Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners.

• Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.

• Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs.

• Coordinates and conducts provider training including developing and distributing provider relations materials.

• May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues.

• May coordinate Provider Manual updates/maintenance.

• Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.

• Research issues that may impact future provider contract negotiations or jeopardize network retention.

Minimum Requirements:

• Requires a Bachelor’s degree ; a minimum of 2 years of customer service experience including 1 year of experience in a Healthcare or Provider environment ; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Experience working in the behavioral health field.

• Experience in education system.

• Experience with Medi-Cal.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $59,724 to $102,384.

Location: California

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.