Manager, Behavioral Health (Clinical Case Management & Care Coordination Services) - 20-07021 (22434685)
This role will start remote until Covid passes and then will be 100% in the office. Open to candidates from Milwaukee, Green Bay who are willing to travel to Appleton 3 days a week.
About the Company:
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
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.
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
- Health insurance
- Dental insurance
- Vision insurance
- Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
- Short- and long-term disability insurance
- Basic Life insurance
- Supplemental AD&D
- Supplemental life insurance
- Wellness Program
- 401(k) retirement with company match
- Employee stock purchase plan
- Vacation, Personal and Sick time
- Paid Company Holidays
- Employee Assistance Program (EAP)
- Training and Learning Opportunities
- Tuition Reimbursement/Educational Assistance
- Service Awards
- On-site fitness center or discount at local fitness centers (most locations)
- Discounts for select local and national products and services, including cell phones, computers and more
- Other amenities may be available, but vary by location
- 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.
- LMSW/LCSW, LMFT or LPC, or a PhD, PsyD or RN license in applicable state. Independent license required.
- RN highly preferred.