Createsand drives behavioral health services that are provided to members. Plans,coordinates and manages overall behavioral health services in a dedicatedWellCare state/region, including clinical operations, provider identification,negotiation, contracting and service functions. Leads the day-to-day operationsfor behavioral health inpatient and outpatient utilization and/or casemanagement activities with focus on achieving quality and service drivenobjectives. Oversees regulatory compliance with laws, regulations and policiesthat govern behavioral health aspects of the business. Acts as the behavioralhealth leadership representative for the state/region.
DEPARTMENT: Health Services
REPORTS TO: VP, Field Health Services
- Drives behavioral health programs through the development of policy and procedure, clinical criteria, workflows and other behavioral health documentation.
- Monitors processes and procedures to ensure compliance with contractual, regulatory (Federal/state) and accreditation entities.
- Provides leadership and support to front-line staff and supervises.
- Provides guidance to Behavioral health management for future expansion and growth efforts.
- Coordinates quality assurance and quality improvement activities with regional and corporate departments.
- Assists with development of member and provider education tools and materials.
- Assists with development of clinically-focused training associated with behavioral health assessment, care plan development and behavioral health services in the state.
- Assists in establishing effective operational practices and works closely with various health plan departments and regulatory agencies to ensure contracts meet operating, financial and legal standards.
- Performs data analysis and develops specific actions to manage medical cost trends.
- Establishes, maintains and fosters professional working relationships with all behavioral health providers and develops regular 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.
- Partners and collaborates with other departments and the corporate office regarding behavioral health matters and initiatives.
- Oversees the day-to-day operations for behavioral health associates which include activities designed to achieve quality of work products and outcomes of individual performers.
- Serves as a community liaison and leader for community advisory boards, advocacy groups, task forces or other community-based stakeholder activities.
- Performs other duties as assigned.
- 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 is required
- Or Registered Nurse with behavioral health background is required
- Required 8 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 5 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
- Advanced knowledge of healthcare delivery
- Advanced demonstrated interpersonal/verbal communication skills
- Advanced ability to create, review and interpret treatment plans
- Advanced ability to effectively present information and respond to questions from families, members, and providers
- Advanced ability to effectively present information and respond to questions from peers and management
- Advanced ability to lead/manage others
- Advanced ability to influence internal and external constituents
- Advanced ability to multi-task
- Demonstrated analytical skills
- Demonstrated written communication skills
- Intermediate ability to work in a fast paced environment with changing priorities
- Advanced Demonstrated organizational skills
- Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
A license in one of the following is required:
- Licensed Clinical Mental Health Counselor (LCMHC)
- Acute Care Nurse Practitioner (APRN) (ACNP-BC)
- Licensed Registered Nurse (RN)
- Licensed Clinical Social Worker (LCSW)
- Licensed Clinical Marriage & Family Therapist (LCMFT)
- Licensed Clinical Professional Counselor (LCPC)
- Licensed Clinical Psychologist (LCP)
- Intermediate knowledge of Microsoft Word, Outlook, Excel, Access is required
- Intermediate Healthcare Management Systems (Generic) experience is required
- Intermediate Financial Management Systems (Generic) experience is required