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Health Services WellCare - Behavioral Health Careers

Behavioral Health Manager Job

Full Job Title: Mgr, Behavioral Health UM

Job Number: 1805963

Location: Tampa, FL

Date Posted: 2018-08-21

Oversees the day to day operations for inpatient utilization, outpatient utilization and prior authorization management activities for multiple markets designed to achieve quality and service driven objectives.

DEPARTMENT: FL-Health Services-M'Caid-St

REPRTS TO: Sr Mgr, Behavioral Health


Essential Functions:

  • Manages and optimizes workflows to achieve successful quality outcomes and benefit maximization within the scope of responsibilities.
  • Serves as an instrumental partner in monitoring and tracking key performance indicators to include identification of over/under utilization patterns and/or deviation from expected results for assigned area/markets.
  • Monitors processes and procedures to ensure compliance with contractual, regulatory (Federal/State) and accreditation entities.
  • Provides leadership and support to front-line staff and supervisors.
  • Monitors and tracks production and quality driven work products and outcomes to individual performers.
  • Provides guidance for inpatient, outpatient and prior authorization management for future expansion and growth efforts.
  • Leads talent management activities to develop and cultivate future leaders.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Required A Master's Degree in Social Work or related counseling field (LCSW, LMFT, LMHC, LPC)
    • Preferred A Bachelor's Degree in Nursing or Healthcare (RN)
    Candidate Experience:
    • Required 5 years of experience in a acute clinical/surgical setting, current experience in utilization management to include pre-authorization, utilization review, concurrent review, discharge planning, and/or skilled nursing facility reviews
    • Required 1 year experience in leading/supervising others in a managed health care setting
    Candidate Skills:
    • Advanced Demonstrated problem solving skills
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to work within tight timeframes and meet strict deadlines
    • Advanced Demonstrated written communication skills
    • Intermediate Ability to lead/manage others
    • Advanced Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to lead/manage others in a matrixed environment
    • Intermediate Knowledge of healthcare delivery
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Other Demonstrate effective critical thinking and decision making skills
    • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
    • Intermediate Other Knowledge of utilization management principles and criteria sets
    • Intermediate Other Strong clinical knowledge of broad range of medical practice specialties
    Licenses and Certifications:
    A license in one of the following is required:
    • Required Other One of the following licenses are required:
    • Required Licensed Registered Nurse (RN)
    • Required Licensed Clinical Social Worker (LCSW)
    • Required Licensed Marital and Family Therapist (LMFT)
    • Required Licensed Mental Health Counselor (LMHC)
    • Required Licensed Professional Counselor (LPC)
    Technical Skills:
    • Required Intermediate Microsoft Word Proficient in Microsoft Outlook applications, including Word,Excel, Power Point and Outlook
    • Required Intermediate Microsoft Excel Ability to use proprietary health care management system
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Healthcare Management Systems (Generic)
    Languages:

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      Last Updated On: 12/9/2015