SUMMARY

This position is responsible for oversight of Behavioral Health (BH) services which includes Mental Health (MH) and substance use disorder (SUD) treatments provided to members to assure the needs of the member are met. This includes a special focus on members with severe and persistent mental illness. This position will also be accountable for oversite of the BH System of Care (SOC) for the service area and advancing the integration of BH with physical health and dental health by performing the following duties.

• Oversees and coordinates BH care across a continuum of care settings to assure appropriate care and achievement of optimal outcomes.


• Drives innovation of the Behavioral Health service delivery in the community.


• Manages BH case management and BH utilization management including prior authorizations.


• Leads the management of contract deliverables and compliance related to Behavioral Health services.


• Ensures a coordinated approach to Behavioral Health care planning while ensuring appropriate use of health care resources.


• Participates in BH utilization review and case management activities.


• Provides BH expertise and consultation services internally to improve member engagement and the effectiveness of the case management, quality management and pharmacy departments.


• Develops strategies to improve the health outcomes of members with severe and persistent mental illness and members with co-occurring BH and complex chronic conditions.


• Contributes to the development of BH integration and parity, and drives implementation of strategies to achieve integration in collaboration with community partners.


• Attends, participates, and/or coordinates regular meetings with community partners to facilitate care coordination, access to care, and program development and monitoring.


• Oversees the determination of appropriate level of care, quality of care, and explores alternative levels of care for members with BH needs.


• Works with the Medical Management team in reviewing complex cases and authorization requests.


• Facilitates orderly and timely transition from one care setting to another.


• Prevents avoidable hospitalization, thus avoiding costs and risks encountered in institutional settings.


• Collaborates with other departments and community partners to improve communication and care processes.


• Participates in process improvement projects and maintains department operating instructions and procedure manuals related to Behavioral Health programs and services.


• Maintains confidentiality and complies with HIPAA rules and regulations.


• Maintains punctual, regular and predictable attendance.


• Works collaboratively in a team environment with a spirit of cooperation.


• Displays excellent communication skills including presentation, persuasion, and negotiation skills required in working with member and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.


• Respectfully takes direction from manager

SUPERVISORY RESPONSIBILITIES

Directly supervises employees performing BH Case Management and BH Utilization Review. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

EDUCATION and/or EXPERIENCE

Bachelor's degree from four-year college or university in a related field; behavioral health provider or THW with at least 5 years of clinical experience; or equivalent combination of education and experience.

COMPUTER SKILLS

Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.

CERTIFICATES, LICENSES, REGISTRATIONS

Active license as a LMFT, LCSW, LPC, THW, psychiatric nurse practitioner, RN, or clinical psychologist.

We provide a competitive salary and excellent benefits, including vacation, medical, dental and vision insurance, and 401(k) pension plan. To apply for this position, please submit a cover letter and resume. We are an Equal Opportunity Employer.

Background Check & Drug Screen Required