ABOUT THE POSITION
We are currently seeking a dynamic Clinical Manager, Utilization Management to join our team at our office in Louisville, KY. To be considered for the position the candidate must reside in Louisville, KY . The Clinical Manager takes a leading role in the oversight of the day-to-day workflow of the Utilization Review clinicians and member service delivery while collaborating with the partnering health plan. The clinical coordination effort is to increase access of care for adults with mental illness through the medical and behavioral health care systems and ultimately, to receive quality care management. The Clinical Manager will be a resource person to team members and Plan case managers, providing support and assistance in application of Beacon's level of care criteria, scheduling, answering questions about policies and procedures and being available to handle and train staff on difficult calls. In conjunction with Corporate Clinical Leadership and the Regional AVP, the Clinical Manager, in conjunction with the Director of Clinical Management will identify training needs for other staff members, assist the clinical department in reaching contractual goals, performance objectives and support the organizational goals of customer service, efficient utilization management, organizational competency and value added case management. The Clinical Manager will lead various efforts to achieve quality customer service, efficient utilization management, and organizational competency through a care management model.
Guide services through the covered benefits for the health plans and line of business.
Assists with overseeing daily workflow of UR team members
Weekly individual and group supervision of team
Primary liaison with partnering health plan to coordinate member care.
Assists staff in the application of level of care criteria as it applies to the client and product lines.
Thorough knowledge of Beacon's level of care criteria and case management protocols to ensure they are met.
Serves as immediate resource to the team to assist with problem-solving
Coordinate with internal departments to ensure member's clinical needs are met
Demonstrated leadership skills and experience, including the ability to work cross-functionally, build consensus and develop staff
Ability to manage time-sensitive projects and meet deadlines
Assists with Quality Improvement activities, including QA, certification, accreditation, and outcome measures.
Responsible for corrective actions identified through record review, fiscal audits, satisfaction surveys and other audits/reviews.
Responsible for various reporting to the health plan and the corporate office.
Review of data to determine trends for clinical innovation to impact member/provider experience and improve metrics related to Risk management. Ensures continued staff development through in-services and development of materials Regular supervision of staff Participates in meetings as assigned.
May provide direct services as needed. Ability to prioritize multiple issues, track multiple projects/tasks and follow through as needed.
- Demonstrated understanding of QI
- Assists and trains clinical staff in handling difficult member/provider calls
- Secondary contact for Plan contract leads
- Supervisory coverage
- Administrator on call duties (AOC)
- Participation in NCQA and URAC activities, as assigned
- Some travel will be required within Kentucky.
- In office work is expected 2-3 days a week, depending on meeting schedules in a given time.
- Other duties as assigned
- Education: Master's Degree Required
Certification: If supervising the Case Management process for three (3) years or more, s/he must hold a certification as a case manager.
Licensures: A current, valid, unrestricted independent license in behavioral health field (including LCSW, LPCC, LMFT) OR current, valid, unrestricted independent nursing license (BSN) and practice within the scope of their licensure
Relevant Work Experience: A minimum of 5-7 years combined direct behavioral health, supervisory and/or managed care experience required. Knowledge of medical necessity criteria and treatment protocols for psychiatric and chemical dependency diagnoses. Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed. Ability to manage and coordinate with internal and external departments
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.