This position is forCare1st Health Plan, a WellCare Healthplans, Inc. company.
Manages overall behavioral health services in a dedicated WellCare market/state. Interacts extensively with the behavioral health leadership and cross functional associates within the market to develop and implement behavioral health program strategies. Directs and facilitates behavioral health clinical training programs for associates, and external behavioral/medical provider community. Assists with behavioral health program and services development of policy and procedure, clinical criteria, workflows and other behavioral health documentation. Serves as behavioral health subject matter expert and supports the needs of the WellCare market leadership. Serves as behavioral health management liaison between the market and the corporate office clinical teams.
Reports to: Sr. Director, Field Health Services
Location: Camelback Rd, Phoenix AZ 85016
Job Type: Salary/Exempt
- Oversees the day-to-day operations for the Behavioral Health services which includes activities for a state specific market designed to achieve quality and service driven objectives.
- 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 market(s) or state.
- Assists with development of clinically-focused training associated with behavioral health assessment, care plan development and behavioral health services in the market(s) or state.
- Implement behavioral health operational priorities and manages resources to operational goals and budgets.
- Establish, maintain and foster professional working relationships with all behavioral health providers and develops regular and ongoing working relationship with the community mental health system in the market including community mental health centers, treatment facilities and other significant behavioral health providers in the market.
- Partners and collaborates with other departments and the corporate office regarding behavioral health matters and initiatives.
- Provides recommendations and support to behavioral health leadership for future expansion and growth efforts.
- Manages and optimizes workflows to achieve successful quality outcomes and benefit maximization within the scope of responsibilities.
- Monitors processes and procedures to ensure compliance with contractual, regulatory (Federal/state) and accreditation entities.
- Monitors and ensures medical expense ratios and approved staff ratios are in line with budget.
- Monitors and tracks production and quality driven work products and outcomes to individual performers.
- Manages work assignments, measures results and initiates personnel actions as required.
- Leads talent management activities to develop and cultivate future leaders.
- Performs other duties as assigned.
- Required A Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position
- Required 7 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning
- Required 3 years of management experience
- Required 4 years of experience in a managed care environment (as a licensed mental health professional )
- Required Other Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Licenses and Certifications:
- Advanced Knowledge of healthcare delivery
- Advanced Knowledge of community, state and federal laws and resources
- Intermediate Ability to influence internal and external constituents
- Intermediate Ability to multi-task
- Advanced Ability to create, review and interpret treatment plans
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Ability to lead/manage others
- Intermediate Ability to work within tight timeframes and meet strict deadlines
- Intermediate Ability to effectively present information and respond to questions from families, members, and providers
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Demonstrated analytical skills
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated organizational skills
- Intermediate Demonstrated problem solving skills
A license in one of the following is required:
- Required Licensed Clinical Marriage & Family Therapist (LCMFT)
- Required Licensed Clinical Mental Health Counselor (LCMHC)
- Required Licensed Clinical Psychologist (LCP)
- Required Licensed Clinical Social Worker (LCSW)
- Required Licensed Clinical Professional Counselor (LCPC)
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft PowerPoint
- Required Intermediate Healthcare Management Systems (Generic)