Provides the clinical oversight, monitoring and education of staff for behavioral health in the assigned market. Ensures access to direct clinical support and services to members upon assignment and for ongoing care. Helps provide direction and management of behavioral health staff located in assigned markets which may include Behavioral Health Concurrent Review, creating individual care plans and case management. Responsibilities also include improvement of clinical outcomes and quality improvement, while improving the consumption health care resources in accordance with WellCare corporate objectives.
Monitors all clinical aspects of behavioral health, and helps establish policy and procedures for behavioral health, including its integration with medical care and pharmacy. Serves as a key representative and spokesperson with respect to the external behavioral health community in the market. Evaluates, diagnoses and treats patients with mental illnesses through a combination of personal counseling and/or medication. Performs initial psychiatric assessments, develops individualized treatment plans, and implements treatment for members.
- Provides clinical oversight in behavioral health for the assigned market. This person will be responsible for monitoring all clinical aspects of behavioral health, including care and utilization management quality improvement, individual health plans, administering care and overall administration including legal and finance.
- Responsible for working within and promoting an integration of behavioral health into all functional areas of the health plan, and working collaboratively with corporate behavioral health and medical staff to implement integrated policies and procedures. Provides reliable assistance to the assigned market medical director and clinical staff to assure effective integration of behavioral services into health plan medical management activities.
- Develops treatment care plans by determining nature and extent of cognitive, emotional, developmental, social, and behavioral disorders; establishing treatment goals and methodologies.
- Provide care to members by utilizing psychotherapeutic methods and medications; discussing progress toward goals with members; providing instructions; monitoring effect of medications; supervising staff provision of services.
- Maintains interdisciplinary treatment by reviewing treatment care plans and progress; consulting and collaborating with primary care physicians, mental health therapists, nurses, and other health care providers.
- Works closely with the market's behavioral health medical director to assure clinical compliance with all company, customer and regulatory requirements for behavioral services.
- Helps establish policy and procedures for behavioral health, including its integration with medical care and pharmacy. This person will be the thought leader for behavioral health, and will provide teaching, training, coaching, and supervision of internal staff.
- Helps lead a continuing improvement and evolution of the delivery of care system in the assigned market, including working collaboratively with providers to encourage development of new and innovative types of care and better integrating BH with physical health and social services.
- In concert with the market's behavioral health medical director, provides leadership, oversight and guidance of behavioral health operations in Health Services clinical management. Ensures that activities are carried out in a timely manner.
- Works with the market behavioral health medical director to assist in the development and maintenance of a strong, quality network of providers.
- Helps establish policy and procedures for behavioral health, including its integration with medical care and pharmacy. This person will provide teaching, training, coaching, and supervision of internal staff.
- Works closely with behavioral health medical director and P&L owners to develop strategies to change member and provider behavior to improve quality of care and clinical outcomes.
- Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards.
- In concert with market behavioral medical director, represents WellCare Health Services at various meetings and conferences on an ongoing basis.
- Participates in the identification and analysis of medical information from multiple sources in order to develop interventions to improve the quality of care and outcomes.
- Makes recommendations (based on daily activities of evaluating members' care) about medical policy, clinical criteria and administrative process.
- Focuses on achieving market, departmental and organizational objectives.
- Complies with company policies and procedures.
- Performs additional duties and responsibilities as assigned by management.
- A MD or DO degree from an accredited medical school and board certification.
- Current license without restrictions in working state or the ability to obtain that license if necessary and ability to acquire license in multiple states.
- Specialty in Psychiatry Board Certified.
- 5 years experience direct behavioral clinical practice required.
- 3 years of experience managed behavioral healthcare industry, Medicare and Medicaid experience preferred.
- 3 years of experience or familiarity with individual care plan administration and care required.
- Demonstrated expertise and experience in Behavioral Health Services, including diagnosis of patients, assessment, treatment plans, and patient monitoring required.
- 3 years of experience in utilization management, case management and community services preferred.
- Ability to effectively present information and respond to questions from families, members, and providers.
- Demonstrated leadership skills.
- Ability to work in a fast paced environment with changing priorities.
- Demonstrated interpersonal/verbal communication skills.
- Ability to multi-task.
- Demonstrated organizational skills.
- Ability to work with community-based BH resources including case management, outreach programs, intensive outpatient treatment programs, homeless programs and other agencies and programs actively addressing BH needs.
- Intermediate proficiency in Microsoft Outlook, Word, Excel, PowerPoint.
- Proficiency in healthcare management systems.