Manager, Clinical - MLTC
Rego Park, NY
- Manage Case Management and Care Coordination services and activities for members with co occurring behavioral health and medical conditions.
- Manage clinical team of licensed medical and behavioral health clinicians.
- Manage clinical services including oversight of clinical policies and procedures and daily activities of integrated care coordination team staff.
- Ensure adequate staffing to conduct case management activities and effectively distribute workloads.
- Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities including chronic physical and behavioral health conditions.
- Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to ensure compliance.
- Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA.
- Ensure compliance with plan’ s emergency management policies, procedures and processes by acting as liaison with other business units.
- Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for members.
- Ensure appropriate case planning, education and interventions are conducted for members defined to be at risk.
- Ensure staff coordinate exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members.
- Monitor data to address quality measures, trends or potential improvement opportunities including provider issues, service gaps and member needs.
- Education/Experience: Bachelor’ s degree in Behavioral Health or related field or Graduate from an Accredited School of Nursing.
- 3+ years case and/or utilization management experience.
- Thorough knowledge in assessment, diagnosis, treatment of individuals with serious mental health or substance abuse disorders, case management, mental health community resources and local health delivery systems.
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
- License/Certification: LCSW, LMFT or LPC, or a PhD, PsyD or RN license in applicable state.
- Independent license required.
- For Specialty Therapy: Bachelor’ s degree in the area of specialty (Speech, Occupational, or Physical) or related field. 5+ years of specialty therapy or utilization management experience.
- Thorough knowledge of a specialized or technical field such as case and/or utilization management, including application of basic theory.
- Knowledge of utilization review procedures and familiarity with educational services.