Manages staff and oversees the day-to-day operations of Behavioral Health care management as it relates to the psychosocial, socioeconomic needs and services of select member populations across a continuum of care. Develops and implements strategies, tactics, policies and programs that drive quality in the establishment of multi-facet approaches to integrated care and systems of care. Represents the Plan and collaborates with internal, government, and community stakeholders as well as the Health Services Leadership team to enhance the quality of services provided to members and to ensure attainment of performance goals.
Reports To: Sr., Director, Field Health Services
Department: Health Services
Position Location: Atlanta, GA 30346
Additional Responsibilities:Candidate Education:
- Focuses on integrating provider services, clinical coordination, and leading the development, implementation and ongoing monitoring of the program and quality initiatives to address the needs of members.
- Partners with Health Services leadership team to implement the vision if integrated care across all Plan activities. Serves as a key resource regarding any issues related to the integration od behavioral health member care across departments.
- Participates in organizational planning, including strategic plans, business plans, and new product development. Partners and collaborates with cross functionally regarding care management initiatives.
- Represents Plan to relevant external stakeholders, such as state government officials, providers/vendors, & advocacy groups with regard to quality improvement initiatives, integrating member care, health plan success, and innovative care strategies.
- Proactively monitors appropriate metrics to drive efficiency and recommends/implements actions to meet or exceed key performance indicators.
- Performs audits of assessments, case plans and service notes to verify cases are properly established and that member coordination activates are occurring and appropriately documented. Collaborates with internal training department to develop materials and job aids to support consistency of process.
- Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
- Directs work assignments, measures results and initiates personnel actions as required. Supports and encourages CM, UM and DM staff to function as an interdisciplinary team.
- With the plan's physician leader, co-facilitates interdisciplinary case rounds to address the needs of members with complex clinical presentations, identifies opportunities for improving rounds, and works with the clinical leadership team to optimize the value of rounds to the clinical staff. Demonstrates the requisite range and depth of subject matter expertise to meet the needs of the covered population.
- Reviews time cards, sets schedules and approves all time off requests for subordinate associates.
- Required A Master's Degree in Social Work
- Required 5 years of experience in complex case work experience, preferably in managed care environment in a community or institutional setting
- Required 5 years of experience in case management, clinical acute care, home health, hospice, physician's office or public health.
- Required 4 years of experience in in a clinical setting
- Required 3 years of experience in in a managed care setting
- Required 1 year of management experience
- Required Other Experience in handling mental health and psychiatric care, family situations, relationship concerns
- Required Other Experience working with managed and non-managed health care benefits
- Required Other Experience with third party relationships, including local community building efforts, governmental and regulatory authorities
Licenses and Certifications:
- Intermediate Ability to analyze information and covert related activities into a comprehensive work plan
- Intermediate Ability to communicate and make recommendations to upper management
- Intermediate Ability to create, review and interpret treatment plans
- Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Intermediate Ability to drive multiple projects
- Intermediate Ability to effectively present information and respond to questions from peers and management
- Intermediate Ability to effectively present information and respond to questions from families, members, and providers
- Intermediate Ability to implement process improvements
- Intermediate Ability to represent the company with external constituents
- Intermediate Demonstrated customer service skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated written communication skills
- Intermediate Knowledge of community, state and federal laws and resources
- Intermediate Knowledge of healthcare delivery
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Ability to lead/manage others
A license in one of the following is required:
- Required Licensed Clinical Social Worker (LCSW)
- Required Licensed Clinical Professional Counselor (LCPC)
- Required Licensed Clinical Marriage & Family Therapist (LCMFT)
- Required Certified Clinical Mental Health Counselor (CCMHC)
- Required Licensed Registered Nurse (RN)
- Preferred Certified Case Manager (CCM)
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft PowerPoint
- Required Intermediate Microsoft Word
- Required Intermediate Healthcare Management Systems (Generic)