Manager, Clinical - MLTC

Rego Park, NY

Posted: 02/18/2019 Category: Other Area(s) Job Number: 25147
  • 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.
For more information on this position, please contact our office at 877-782-3334.

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