About

Southwest Behavioral Health Management, Inc

Southwest Behavioral Health Management, Inc., founded in 1998, is a non-profit corporation that is the primary contractor for the collaborative Behavioral Health HealthChoices contract for Armstrong, Butler, Indiana, Lawrence, Washington and Westmoreland counties in Southwestern, Pennsylvania. SBHM is the administrative management body that is governed by a board of directors including a representative from the Human Services and Substance Use Disorder programs from each of the six counties . Two ex-officio board members represent members, families and/or advisory groups on the board of directors.

The Northwest Behavioral Health Partnership, Inc., founded in 2007, is the primary contractor for the collaborative Behavioral Health HealthChoices contracts for Crawford, Mercer and Venango counties in Northwestern, Pennsylvania. NBHP is managed by SBHM and governed by its own board of directors including a representative from each of the three Northwest counties' Human Services and Substance Use Disorder programs.

SBHM is staffed with a multi-disciplinary team that fulfills the administrative and operational duties of the NW and SW contracts. The role of our teams is to serve the counties, collectively and individually, in their respective areas of expertise, including: Fiscal Responsibility, MH and SUD Project/Program Development, Consultation, Training, Technical Assistance and Data Reporting.

Administration:

Supports Executive Management Team with daily operations
Coordinates and acts as liaison between the BH-MCO, County Staff, Corporate Board of Directors, HealthChoices Team Leaders and the Office of Mental Health and Substance Abuse
Responsible for the overall function of the Corporation

Operations:

Assists in identifying and defining special projects and initiatives based upon Member and County need within our region, as well as planning in accordance with recognition of emerging trends and changes in state, local and federal initiatives and requirements
Develops and plans for project implementation, which utilizes and coordinates the resources, experience and expertise within the organization’s clinical, information systems (IS), quality and financial departments to support HealthChoices programming across the communities and counties served
Assists Executive Director with county specific prioritizing and planning, as well as organizational strategic planning for the corporation
Coordinates efforts, tracks progress and works to identify and resolve any issues, tracks projects after implementation to assure customer satisfaction as well as outcomes
Collaborates with committees across the nine counties, SBHM management team, the BH-MCO, in the development, review and approval of projects and initiatives including CBCM and VBP planning
Identifies, coordinates and facilitates training opportunities for county administrators, staff and providers to ensure accurate and timely information on new opportunities for behavioral health and substance use treatment and care, while optimizing programming through ongoing monitoring of best practice standards across the region
Develops, plans, and manages all aspects of past and current reinvestment plans and RFPs with counties
Supports and seeks grants and other funding opportunities that may be applicable to proposed projects
Participates in the planning and development of clinical programming at the State and County levels
Provides a wide range of management and administrative support activities in the daily operations of the organization and the counties served through the ongoing resolution of corporate operational issues

Finance:

Fiscal responsibility for the HealthChoices program
Oversees medical expenses, administrative expenses and cash management
Performs actuarial and statistical analysis for the program
Adheres to risk compliance requirements for the primary contractor
Rate development and ongoing analysis of current rate structure to ensure adequate program funding
Maintains financial reporting software unique to the SW6 counties
Reviews and coordinates responses to all DHS financial correspondence
Responsible for the SBHM Corporation financial and human resource activities

Information Technology

Ensures that the BH-MCO maintains a comprehensive Management Information System to support the data integrity established by the Pennsylvania Department of Human Services
Responsible to adhere to the data reporting requirements and accuracy of DHS required reports for the HealthChoices program
Develops and monitors HIPAA compliance policies and procedures
Maintains functional WAN/LAN and remote access network
Maintains data security procedures and emergency disaster plan
Maintains SOC I and II controls and certification
Provides a de-identified utilization reporting tool for SBHM and county staff
Provides oversight on information system solutions between provider network and BH-MCO
• Performs Business Process Reporting and Analysis of SBHM, Inc. Triage Process; coordinates monthly triage meetings with county personnel and monitors cost driver utilization
Provide technical assistance and training to counties
Maintenance and production support of our corporate data warehouse; develop data collection instruments and utilizes instruments and methods for the evaluation and quality control of research or operational data and collect, analyze, interpret, and summarizes data in preparation for generation of statistical and analytical reports
Develop and maintain high quality, recurring dashboards and reports for internal and external stakeholders

Quality:

Develops and administrates quality management planning for the HealthChoices contract
Ensures the compliance of the BH-MCO Quality Management Program with the HealthChoices contract through routine review of all BH-MCO submissions and auditing of BH-MCO processes
Reviews and resolves quality of care concerns
Participates in and coordinates with all statewide quality management studies/projects on performance improvement initiatives
Develops and implements quality improvement planning within the counties
Tracks and reviews reportable/serious reportable events
Ensures adherence to the Healthchoices Contract with regards to member rights, dissemination of information, handbooks, telephone lines and access, notification of changes, public education programs and materials, etc.
Provides for member feedback and input through Member Advisory Committees and member representation on oversight committees and workgroups and complaints and grievances committees
Ensures compliance with Healthchoices contract regarding all denial, complaints and grievances processes
Facilitates grievance and level 2 complaint committees
Ensures adherence of the BH-MCO Compliance Program with the Healthchoices contract and BPI standards
Serves as Primary Contractor Compliance Coordinator
Ensures adherence to all Healthchoices contract and program standards, regulations and appendices through a compliance and continuous quality assurance process. Reviews Policies and Procedures. Administers and follows up on corrective action when necessary
Participates in the planning and development of clinical programming at the State and County levels
Monitors member geographical access to services and develops strategies to meet access needs