Supervisor, Behavioral Health Utilization Management

Centene•Arlington, TX

3d•Remote

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Behavioral Health UR Clinical Call Center Environment - Coverage: 365/24 -7 NOTE: Applicants MUST be fully licensed and approved for the state of Texas. Applicants may reside anywhere in continental US. Work Schedule: Monday - Friday: 8 am - 5 pm (CST) and requires On Call Rotations for Holidays and Weekends Position Purpose: Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines Monitors and tracks UM BH resources to ensure adherence to performance, quality, and efficiency standards Works with BH utilization management team to resolve complex BH care member issues related to BH Maintains knowledge of regulations, accreditation standards, and industry best practices related to BH utilization management Works with BH utilization management team and senior management to identify opportunities for process and quality improvements within utilization management Educates and provides resources for BH utilization management team on key initiatives and to facilitate on-going communication between BH utilization management team, members, and providers Works with the BH senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services Evaluates BH utilization management team performance and provides feedback regarding performance, goals, and career milestones Provides coaching and guidance to the BH utilization management team for optimal performance management and provides counseling and corrective action when required Assists with onboarding, hiring, and training BH utilization management team members Attends company meetings in absence of people leader Acts as primary contact for escalated calls/issues that require research or special handling Leads and manage others in a matrixed/cross functional environment Leads and champions change within scope of responsibility Presents information and responds to questions from peers, leaders and internal/external customers Performs other duties as assigned. Complies with all policies and standards.

Requirements

Requires a Master's degree or Graduate of an Accredited School of Nursing +4 years of Behavioral Health /Psychiatric related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Knowledge of Utilization Management.
Prior supervisory experience.
Understanding of medical necessity criteria.
LCSW- License Clinical Social Worker required or LPC - Licensed Professional Counselor required or LMFT - Licensed Marital and Family Therapist required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Nice To Haves

Direct experience with Utilization Review or Utilization Management related to Behavioral Health case is preferred
Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse
Experience working with providers and healthcare teams to review care services, precertification, concurrent review, discharge reviews for mental health and substance abuse cases
Direct IOP Behavioral Health and/or SUD inpatient hospital experience
Direct work experience in Behavioral Health UR, UM, or CM in Managed Care Organizations, In-Patient Behavioral Health Units, Partial Hospitalization, or Residential Treatment

Responsibilities

Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team.
Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines
Monitors and tracks UM BH resources to ensure adherence to performance, quality, and efficiency standards
Works with BH utilization management team to resolve complex BH care member issues related to BH
Maintains knowledge of regulations, accreditation standards, and industry best practices related to BH utilization management
Works with BH utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
Educates and provides resources for BH utilization management team on key initiatives and to facilitate on-going communication between BH utilization management team, members, and providers
Works with the BH senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
Evaluates BH utilization management team performance and provides feedback regarding performance, goals, and career milestones
Provides coaching and guidance to the BH utilization management team for optimal performance management and provides counseling and corrective action when required
Assists with onboarding, hiring, and training BH utilization management team members
Attends company meetings in absence of people leader
Acts as primary contact for escalated calls/issues that require research or special handling
Leads and manage others in a matrixed/cross functional environment
Leads and champions change within scope of responsibility
Presents information and responds to questions from peers, leaders and internal/external customers
Performs other duties as assigned.
Complies with all policies and standards.