Interacts extensively with the behavioral health leadership and cross functional associates within the organization to develop and implement long range behavioral health program strategies. Serves as project manager for projects and initiatives around integration both internally with associates and externally with providers. Directs and facilitates behavioral health clinical training programs for associates, and external behavioral/ medical provider community. Assists with BH program and services development of policy and procedure, clinical criteria, work flows and other behavioral health documentation and product development activities.
DEPARTMENT: Health Services-Behavioral Health
REPORTS TO: Behavioral Health Medical Director
- Project leads behavioral health and/or behavioral health home program development and integration activities both internally and externally.
- Improves quality of behavioral health product by driving cross functional initiatives.
- Utilizes data to identify and manage change necessary to achieve performance improvement.
- Communicates and educates associates on behavioral health strategy.
- Develops behavioral health clinical educational materials, and performs provider behavioral health education.
- Works to develop and enhance relationships within the provider community, including behavioral health homes, community mental health centers, hospitals and individual providers (BH Providers and PCP's) and groups identified that are participating in Physical/ Behavioral integration activities.
- Designs, develops and implements behavioral health related clinical training for associates and providers.
- Works with utilization, case and disease management teams to implement and operationalize BH/PH integration iniatives.
- Educates health plan leadership and cross functional staff on behavioral health and integration strategy ensuring all entities understand and support the initiatives.
- Produces professional presentations and training materials to be utilized for training of providers and associates.
- Manages behavioral health specific policy and procedure development, clinical program descriptions, and other related documentation requirements.
- Assists with behavioral health provider and/or home provider audits as needed.
- Assists with analysis of behavioral health utilization data, KPI review and monitoring of behavioral health utilization management metrics. Participates with development of corrective action plans and associated activities for areas that need improvement.
- Performs duties and responsibilities as assigned
- Assist behavioral health home candidates to prepare their organization for becoming Patient-Centered Specialty Practice (PCSP) recognized through NCQA.
- Oversees compliance with behavioral health home contracts and standards.
- Required a Master's Degree in counseling, social work, psychology, nursing, or related human service field
- Required 5 years of experience in behavioral health, preferably in public sector
- Preferred managed healthcare experience
- Intermediate ability to lead/manage others in a matrixed environment
- Intermediate demonstrated project management skills
- Intermediate ability to work independently Ability to work independently or part of a team
- Intermediate ability to work as part of a team
- Intermediate strong people skills
- Intermediate ability to apply Lean/Six Sigma industry standard application and methodologies preferred
- Intermediate comfortable presenting in front of large groups
- Intermediate ability to redefine business approaches and processes to meet objectives
- Intermediate ability to think outside the box, structure an ambiguous opportunity, determine ROI and build business case for projects
- Intermediate possess strategic enterprise wide view while maintaining attention to detail
Licenses and Certifications:
A license in one of the following is required:
- Required Licensed Clinical Mental Health Counselor (LCMHC)
- Required Advanced Practice Registered Nurse (APRN)
- Required Licensed Clinical Marriage & Family Therapist (LCMFT)
- Required Licensed Clinical Social Worker (LCSW)
- Required Licensed Registered Nurse (RN)
- Required Advanced Microsoft Word, Powerpoint, Excel, Project and Outlook
- Required Advanced Microsoft Excel Ability to learn company approved software
- Required Intermediate Healthcare Management Systems (Generic)