Serves as the key external-facing member of the behavioral health network management team for the behavioral health professional network in their designated geographic area
Analyzes membership and geographical access by BH Specialty to determine specific goals and action plans for targeted recruitment of new practitioners
Performs activities that develop prospective relationships with providers by supporting and participating in the recruitment and maintenance of the behavioral health provider network
Provides input to behavioral health special payment arrangement contract renewals
Informs and educates behavioral health practitioners on Horizon's products and services
Engages in proactive outreaches to high volume behavioral health groups in their designated territories
Analyzes provider related information and data to recommend actions and solutions to strengthen the provider’s relationship with Horizon
Initiates communication with other members of BH network management team to effectively troubleshoot complex claim situations
Alerts leadership to potential issues risks, and opportunities identified through behavioral health network interactions
Plans, organizes, and presents seminars to various BH network practitioners and groups
Maintains a thorough knowledge of healthcare industry trends and developments
Identifies, researches, recommends and implements potential saving opportunities for the delivery of cost-effective and quality care

High School Diploma/GED required
Bachelor degree preferred or relevant experience in lieu of degree
Requires a minimum of five (5) years healthcare experience, preferably with provider or client focus/interaction
Prefers behavioral health related experience in the healthcare/insurance industry
Requires knowledge of healthcare industry
Requires knowledge of New Jersey behavioral health provider community
Prefers knowledge of HBCBSNJ programs, products and procedures.

Behavioral Health Network Specialist

Key skills