Clinical Program Manager - Remote in New York

UnitedHealth Group•East Syracuse, NY

3d•Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. This position is remote and candidate manages a team of at least 20 to 22 staff in size responsible for utilization review / case management in a call center environment. Team is responsible for utilization review / case management of inpatient and outpatient Behavioral Health services and determining medical necessity could have oversight of case management staff that work directly with members telephonically and in the field. This is a Monday – Friday role but may require some holiday work. Position provides clinical and medical management services, including case management, health assessments, interventions and discharge planning. May identify, coordinate or provide appropriate levels of care under the direct supervision of an independent licensed clinician. If you are located in New York, you will have the flexibility to work remotely as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

New York active and unrestricted Master's level professional independent license in one of the following: Licensed Clinical Social Worker (LCSW); or Licensed Mental Health Counselor (LMHC); or Licensed Psychologist, OR Registered Nurse (RN) with 5+ years of Behavioral Health experience
6+ years of CUD and BH experience
5+ years of experience with the Child Adolescent population
2+ years of supervisory experience and extensive skills in working with the public
Experience in the state of New York mental health and substance abuse services delivery system
Experience working in a managed care organization (MCO)
Experience with Medicare and Medicaid regulations
Knowledge of principles and practices of public and commercial mental health service delivery systems
Flexibility with working evenings, weekends, and holidays

Nice To Haves

Experience working with the New York provider network
Knowledge of evidence-based, best and promising practice methods and procedures and solid customer service orientation
Familiarity with Prior Authorization process and requirements
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
Proficiency in Microsoft applications
Dedicated work area established that is separated from other living areas and provides information privacy
Have access to high-speed internet (DSL or Cable)

Responsibilities

Oversight of utilization management of adults, adolescents and children as well as dual eligible Medicare/Medicaid populations with SMI, SUD, co-occurring physical health, co-occurring disorders of MH and SUD, and co-occurring mental health and/or substance use disorders
Oversight of utilization management must be an Independently licensed clinician in the state of New York with experience working in a Behavioral Health managed care setting or Behavioral Health clinical setting and knowledge of Behavioral Health rehabilitation and recovery services
Manages and is accountable for professional employees and supervisors
Sets team direction, resolves problems and provides guidance to members of team
May oversee work activities of other supervisors
Adapts departmental plans and priorities to address business and operational challenges
Influences or provides input to forecasting and planning activities
Oversight of new product implementations
Initiating process for state initiatives and directives
Updating and creation of Quick Reference Guides
Oversight and coordination of care with internal and external partners
Familiarity with and experience Interfacing with regulatory agencies
Interview, hire and onboard new employees
Review reports for team members to insure adherence to established benchmarks
Provides coverage for management team as needed
Fosters relationship with leadership and medical directors