Behavioral Health, Leader, Behavioral Health
Full-time, Exempt: Yes
The Behavioral Health Leader provides professional oversight, leadership and guidance over the day-to-day operation of the Behavioral Health Care Management Team. Ensures the development, implementation, coordination, and evaluation of the Team’s job responsibilities. Develops and monitors productivity metrics. Performs quality checks, audits, coordinates interrater reliability activities, and supports the team in meeting their productivity measures. Monitors quality process to meet NCQA regulations and acts as liaison with UM compliance. Designs and maintains processes and work-flows to support internal programs and coordination with other interfaces as relevant. Interviews, recommends for hire, orients, evaluates, and counsels team members. Resolves complex issues with staff. Prepares and presents complex cases and issues to the Director. Participates as the operational SME for State reviews. Receives and analyzes performance and activity reports, creating action plans as required. Knows and interprets MVP contracts, policies and procedures. Acts as a liaison between the care management teams and the strategic business units (SBUs), internal staff, Medical Director, community partners and other MVP service providers. Interacts with other departments to define data requests, test system performance and evaluate process improvement opportunities. Interacts with Member Services, Provider Relations, Quality Improvement, Compliance, and Finance to identify utilization trends. Responsible for afterhours call schedule, reporting and back-up as needed for CM/UM tasks. Performs other duties as assigned.
Master’s degree with a license as a mental health clinician (LCSW, LMHC), or licensed Registered Nurse (RN) with mental health experience.
New York State licensure required with previous mental health or substance abuse experience.
Case Management Certification preferred (ANCC or CCM).
Minimum of 2 years of recent mental health or substance abuse experience required.
Prior supervisory or Team Lead experience is preferred.
Behavioral Health UM and/or Case Management experience in a managed care organization is preferred.
• Capable of independent thinking with excellent problem solving skills.
• Strong interpersonal and communication skills required. Independent thought process; oriented toward probling and problem solving.
• Computer literacy required (Microsoft office skills). Ability to navigate multiple computer systems concurrently required.
• Ability to interact with providers and physicians on delicate matters required.
• Excellent written and verbal communication skills.
• Ability to exercise discretion in handling confidential member information.
• Detail oriented with strong organizational skills including the ability to manage time wisely to meet the established deadlines.
• Ability to work in an energetic team environment.
• Must demonstrate understanding of Behavioral Health, Substance Use, and psychosocial issues that may alter treatment or care plans and be able to demonstrate good judgment when dealing with emotionally charged situations.
• Ability to supervise and train on site and e-worker staff, including organizing, prioritizing, and scheduling work assignments required. Travel to regional offices when needed.
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- Job Family Medical Management/Clinical
- Pay Type Salary
- Headquarters Office, Schenectady, New York, United States of America
- Rochester Office, Rochester, New York, United States of America
- Tarrytown Office, Tarrytown, New York, United States of America