Associate Director, Utilization Management - Behavioral Health

CareSource•Boston, MA

13d

About The Position

The Associate Director, Utilization Management – Behavioral Health assists UM leadership in leading and managing all functions within behavioral health management to ensure consistent, efficient delivery of services throughout the healthcare continuum and demonstration of positive outcomes. Essential Functions: Collaborate with market and enterprise leaders to support development and knowledge transfer for Behavioral Health UM Monitor effective use of prior authorizations, policies, and benefits to ensure consistent, effective and efficient delivery to members while meeting regulations and internal financial objectives Facilitate and promote problem identification, analysis, and resolution Proactive monitoring of regulatory requirements and meet State contract requirements for existing and new populations Ensure Behavioral Health UM programs and operational processes are properly developed and aligned to the organization’s strategic goals Determine benchmarks, goals and outcomes for staff and implement an accountability system Monitor CQI activities in accordance with regulatory requirements and accreditation standards In partnership with UM leadership, review available reporting to analyze trends, identify opportunities and ensure alignment with polices & procedures Develop and coach employees Build succession plan inclusive of manager and team Foster relationships with hospitals, physicians and community agencies to improve member and provider satisfaction Identify and report risk management issues for the department and CareSource as a whole Perform any other job duties as requested

Requirements

Bachelor’s degree in nursing or related field required or equivalent years of relevant experience required
Minimum of five (5) of experience in utilization management in an MCO required; quality improvement and/or project management background preferred
Minimum of three (3) years management experience required
Proficiency in Microsoft Office products including Word, Excel and PowerPoint
Leadership experience and skills
Change agent
Decision making/problem solving skills
Clinical data analysis and trending skills
Critical and systems thinker
Knowledge of trends in healthcare, managed care, Medicaid, behavioral health, and quality improvement
Excellent communication skills, both verbal and written
Management skills including human capital and project management
Ability to work independently and within a team environment
Attention to detail
Understanding of predictive modeling process/tools
Training/teaching skills
Strategic management skills
Negotiation skills/experience
Politically astute
Program grammar usage, phone etiquette and technical writing skills
Time management skills
Customer service oriented
Current, unrestricted license as a Registered Nurse (RN), Licensed Social Worker (LSW), Psychologist, or Professional Clinical Counselor (PCC) is required

Nice To Haves

Master’s degree preferred
Internet research skills preferred
Managed Care, Utilization management Case Management and/or Quality Improvement certification preferred

Responsibilities

Collaborate with market and enterprise leaders to support development and knowledge transfer for Behavioral Health UM
Monitor effective use of prior authorizations, policies, and benefits to ensure consistent, effective and efficient delivery to members while meeting regulations and internal financial objectives
Facilitate and promote problem identification, analysis, and resolution
Proactive monitoring of regulatory requirements and meet State contract requirements for existing and new populations
Ensure Behavioral Health UM programs and operational processes are properly developed and aligned to the organization’s strategic goals
Determine benchmarks, goals and outcomes for staff and implement an accountability system
Monitor CQI activities in accordance with regulatory requirements and accreditation standards
In partnership with UM leadership, review available reporting to analyze trends, identify opportunities and ensure alignment with polices & procedures
Develop and coach employees
Build succession plan inclusive of manager and team
Foster relationships with hospitals, physicians and community agencies to improve member and provider satisfaction
Identify and report risk management issues for the department and CareSource as a whole
Perform any other job duties as requested