Behavioral Health Clinical Program Manager - Remote, New York

UnitedHealth Group•New York, NY

6d•$91,700 - $163,700•Remote

About The Position

The Clinical Program Manager oversees a remote team of Behavioral Health Care Advocates responsible for utilization management (UM) and case management (CM) of inpatient and outpatient Behavioral Health services. UM is performed via an inbound telephonic queue and requires team members to work a holiday rotation. Case managers work directly with members both telephonically and in the field. The schedule is Monday – Friday, 8a – 5p EST and may include working some holidays. If you are located in New York, you will have the flexibility to work remotely as you take on some tough challenges. Licensure and residency in New York are required.

Requirements

Licensed Clinician in the State of New York with one of the following licensures. Licenses must be active and unrestricted: Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Psychologist (LP)
6+ years of Behavioral Health experience including Mental Health and Substance Use Disorders
5+ years of utilization management experience including prior authorizations, concurrent reviews, appeal processes, and UM tools related to level of care determinations and medical necessity (i.e., LOCUS, CALOCUS, LOCADTR)
5+ years of experience working with the under-21 population
5+ years of experience working with the adult population
3+ years of experience managing people in a Behavioral Health setting (i.e., hospital, MCO, mental health clinic), including performance reviews
3+ years of experience with New York public and commercial mental health and substance abuse services delivery system
Experience overseeing documentation in Electronic Medical Records (EMR)
Experience with Medicare and NY Medicaid products and regulations
Experience interfacing with regulators during audits
Intermediate proficiency in Microsoft Office Suite, including MS Excel
Ability to work holidays based on business needs
Dedicated, distraction-free workspace and access to high-speed internet in home
Residency in New York

Nice To Haves

Experience working in a Managed Care Organization (MCO)
Experience working with the New York provider network
Experience managing clinical and non-clinical phone queues
Experience managing a remote team
Experience or familiarity with case management services
Knowledge of evidence-based practices and procedures
Demonstrated competence in clinical care management, solid leadership and organization skills, interpretation of State and federal laws, and regulations relevant to the mental health program area
Solid customer service orientation

Responsibilities

Oversee utilization management for diverse populations, including adults, adolescents, children, and dual-eligible Medicare/Medicaid members with SMI, SUD, and co-occurring behavioral and physical health conditions
Manage and be accountable for professional employees and supervisors
Set team direction, resolve problems, and provide guidance to members of team
Adapts departmental plans and priorities to address business and operational challenges
Influence or provide input to forecasting and planning activities
Oversee new product implementations
Initiate processes for state initiatives and directives
Update and create Quick Reference Guides
Oversee and coordinate care with internal and external partners
Interface with regulatory agencies
Interview, hire, and onboard new employees
Review reports to ensure team member adherence to established benchmarks
Foster relationships with leadership and medical directors
Cover for management team as needed
May oversee work activities of other supervisors