Sr Manager, Clinical Services

University of Massachusetts Medical School•Westborough, MA

About The Position

Under the direction of the Director, Clinical Services, the Sr. Manager, Clinical Services manages and oversees the daily functioning of all direct reports supporting assigned contracted clinical work. This position is also responsible for ensuring compliance with all applicable state and federal laws and regulations and necessary procedures governing the assigned contract(s) work requirements.

Requirements

Bachelor’s Degree and licensure in appropriate healthcare field
At least 7 years’ disability related experience or equivalent such as in community-based mental health services and/or long-term care services
2 years recent management/supervisory experience
Ability to work in and foster a team environment
Excellent written and oral communication skills
Able to travel to off- site locations

Nice To Haves

Registered Nurse with bachelor’s degree in Nursing; Master’s Degree in Social Work; bachelor’s level Certified Rehabilitation Counselor; and/or licensure in Physical, Occupational or Speech Therapy
Knowledge of Mass Health regulations
Knowledge of applicable regulations required for the position and specific program(s) the position supports
Strong analytical and problem-solving skills
Proficient in Microsoft Office programs including Word and Excel

Responsibilities

Provide supervision and daily guidance to clinical managers and lead staff ensuring that the service provided meets or exceeds clinical and procedural standards as outlined in the assigned contract(s).
Foster team environment and provide professional and clinical leadership to clinical and administrative program staff, as appropriate.
Direct and assist clinical managers and lead staff in identifying and addressing issues involving team process, clinical workflow, practices and function, as well as monitoring staff scheduling and workload coverage.
Monitor the process and outcomes of clinical staff to ensure adherence to appropriate state and federal regulations, as well as all program policies and procedures.
Provide clinical guidance to clinical managers and lead staff related to all clinical contract requirements which are specific to the contract or work assigned (i.e., clinical evaluations, prior authorizations and clinical eligibility determinations).
Review, revise, implement and communicate policy, workflow, and organizational changes to clinical staff.
Prepare and present reports per contractual requirements and as requested.
Oversee the review process, assignment of cases, and outcomes of evaluations.
Work closely with Program Management and Clinical Staff to ensure that clinical integrity is maintained in the assigned program.
Coordinate and lead assigned multidisciplinary team meetings including case review as needed.
Collaborate with the Medical Director to plan physician, psychologist, and nurse practitioner team assignments and schedule.
Oversee the clinical training program for newly hired staff and ongoing skill-building.
Establish competency requirements for clinical staff roles.
Conduct onboarding activities and performance evaluations of all assigned staff.
Interface with Human Resources Department on personnel related issues as needed, including recruitment, hiring and termination of staff.
Maintain the confidentiality of all business documents and correspondence.
Identify necessary resources to perform program work, monitors work progress including, data analysis and report development, and oversees its timely completion.
Participate in performance improvement initiatives and demonstrate the use of quality improvement in daily operations, including conducting regular quality reviews of clinical services authorized and competency assessments for clinical staff.
Support team members in providing clinical information and case details related to the appeal and/or grievance process.
Comply with established departmental policies, procedures and objectives.
Comply with all health and safety regulations and requirements.
Assist the Director in preparing annual goals and objectives for the program.
Act as Liaison between client agencies and assigned programs on clinical and case-related issues.
Act as Liaison between client agency operational units regarding issues impacting contract performance including member/participant matters.
Work closely with the Program Director to explore new business initiatives for ForHealth Consulting.
Other duties as needed in support of the department and the organization.