Manager, Behavioral Health UM and Programs

Point32Health

18d

About The Position

Under the oversight of the Director, Behavioral Health, the Manager, Behavioral Health is responsible for leading at least one Behavioral Health functional team, managing team performance and results, and for managing the clinical processes that support the Behavioral Health department. The Manager, Behavioral Health is a member of the Behavioral Health leadership team; in addition to their own responsibilities the Manager assists in supporting and covering for other Behavioral Health leaders and participates in a variety of cross-functional Behavioral Health initiatives and processes. The Manager, in collaboration with the Director, is responsible for the development, implementation and maintenance of Behavioral Health initiatives and projects, as well as achievement of goals consistent with federal, state, and national requirements and regulations, and specific Tufts Health Plan initiatives and goals. The position is responsible for representing the Behavioral Health department on relevant internal and external work groups, implementation teams, and projects, for interfacing with divisional and enterprise teams, and for managing Behavioral Health accreditation compliance.

Responsibilities

• Manage daily operations including, but not limited to, the assignment and distribution of work among assigned Behavioral Health Utilization Management team(s). Ensure all workflow processes are completed within the required timeframes and telephone coverage requirements are met. Ensure adherence to all department and regulatory standards.
• Serve as member of Behavioral Health leadership team. Provide back-up for peers, including supervisory coverage. Partner with peers to ensure effective cross-functional, end to end approach to meet the needs of members, providers, and internal and external stakeholders.
• Support and help drive efforts to integrate Behavioral Health into the broader Tufts Health landscape by providing a cohesive behavioral health presence and subject matter expertise to Public Plans and Enterprise activities including case management, medical management, and provider/network management.
• Under the direction of the Director of Behavioral Health, develop, implement and manage initiatives and projects to achieve Tufts Health Public Plans goals. Collaborate with internal departments in support of clinical activities and operations. Manager of Children’s Behavioral Health Initiative (CBHI) team completes extensive network management activities in coordination with MassHealth and other MCOs/ACOs.
• Develop and prepare reports to meet internal, regulatory, contractual and accreditation requirements. Work closely with other departments in the development of report specifications and obtain data for and/or complete reports as needed to meet contract and regulatory requirements and track ongoing data.
• Hire, train, and manage staff. Supervise/coach staff to assist them in attaining optimal knowledge and job efficiency. Define metrics and goals for assigned team(s) and manage expectations. Utilize data to monitor and evaluate individual, team and program performance. Provide timely feedback to all staff regarding their performance via regular team and one-on-one meetings. Conduct formal performance appraisals. Take appropriate disciplinary action in a timely manner when needed. Ensure staff is provided with all necessary tools, resources and training to promote growth and performance within the department and/or organization.
• Monitor utilization management and ensure servicing goals are met or exceeded by tracking department metrics. Apply data, utilize evidence-based treatment practices and identify opportunities for improvement of quality of care and medical expense savings to design, implement and enhance utilization management and clinical care coordination processes. Track and monitor the impact of utilization management and care coordination on quality and medical expense measures. Complete monthly clinician case review audits and review semi-annual IRR results to monitor UM decision making and adherence to policies and procedures. Identify trends, develop and implement action plans for improvement progress
• Provide monthly Care Management report on team(s) performance, metrics, and goal achievement to the Director of Behavioral Health. Review and develop department policies, procedures, workflows and job aids as needed, consistent with departmental and company strategic objectives and mission. Develop, maintain, update orientation materials in collaboration with clinical trainer.
• Work collaboratively on and manage components of quality improvement initiatives and medical expense reduction activities and ensure alignment with broader company strategy. This includes activities that support NCQA accreditation and identify and promote best practices within clinical programs. Provide information and support to internal stakeholders. Work collaboratively with other managed care entities, MassHealth, the Executive Office of Health & Human Services, as well as provider and other stakeholder groups.
• Other duties and projects as assigned.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed