Utilization Management and Clinical Coordination Section Manager (SPM II)

King County • Seattle, WA

12h • Hybrid

About The Position

The Special Projects Manager II of the Utilization Management and Clinical Coordination section is responsible for leading the King County Behavioral Health and Recovery Division's (BHRD) activity in behavioral health utilization management and care coordination. The position reports to BHRD's Chief Medical Officer and is responsible for managing a team of care authorizer supervisors and care authorizers/care coordinators, the client services line and various projects related to coordinating care for individuals across the behavioral health system. Care coordination, connecting individuals with the most appropriate level of behavioral healthcare, and effective utilization of available behavioral health resources are integral to behavioral health system improvement in King County and require a visionary leader. The core duties of this position include management and oversight of behavioral health initiatives that impact care coordination and utilization management for behavioral health outpatient, SUD residential treatment, Partial Hospitalization Programs, Crisis Stabilization Units, and specialty eating disorder treatment. This care impacts over 40,000 individuals per year and requires coordination and integration across multiple agencies. The Manager will be a primary contact on care coordination and utilization management concerns and a collaborator with key behavioral health system partners, such as Medicaid Managed Care Organizations (MCO’s), residential and outpatient treatment providers, inpatient providers, and emergency/crisis care providers. They will be responsible for managing Medicaid and non-Medicaid authorizations of over $181M annually, client services, and adverse benefit determination. They will have responsibility for overseeing and implementing innovations in effective sharing of information, easing transitions from different levels of care, expansion of technology tools, and ensuring the right level of care and support for King County residents needing behavioral health treatment. The Manager of the Utilization Management and Clinical Coordination section will also be a critical member of the BHRD management team.

Requirements

• Bachelor's degree in human services or related field. Qualifying experience may substitute one year for one year of education.
• Two years of recent experience working as a manager or supervisor in behavioral health.
• A minimum of 5 or more years of professional experience in Behavioral Health.
• Knowledge of principles of equity and social justice, and demonstrated ability to work with individuals from diverse backgrounds.
• Strong interpersonal skills, including a collaborative approach and good listening skills.
• Advanced knowledge of and recent experience in care coordination services.
• Demonstrated experience in utilization management to determine medical necessity and appropriate provision of needed behavioral health services.
• Leadership in the delivery of recovery-oriented care that is built on the strengths and resilience of individuals, families, and communities who are actively engaged in their health, wellness, and recovery.
• Knowledge and experience with Centers for Medicare and Medicaid Services (CMS) rules and regulations related to behavioral health.
• Demonstrated ability to manage projects using effective project management principles, methodologies, and processes.
• Skill in organizing, planning, and executing large-scale, complex multiphase projects requiring multiple organization integration from vision through implementation.
• Advanced skill in effectively communicating orally and in writing, including making formal presentations to groups and committees, influencing decision makers in a political environment, and working with the media.
• Skill in gathering, analyzing, and synthesizing data; writing papers and reports, including the ability to present statistical and narrative information to non-technical stakeholders.
• Skill in problem-solving, conflict resolution, and decision-making; handling multiple competing priorities.

Nice To Haves

• Master's degree in human services or related field and/or equivalent education and work experience.
• Knowledge of King County’s behavioral health service system, social service network, and evidence-based and promising practices.
• Licensed as a mental health professional and/ or substance use disorder professional.
• In recovery or have lived experiences in behavioral health.

Responsibilities

• Manage and oversee all section staff, including employee development, performance management, team development, and facilitation of staff meetings
• Determine charter and scope of section projects, assuring projects are aligned with County/Department strategies, initiatives and business needs or values. This position also holds responsibility for ensuring day-to-day project activities are met and developing recommendations to ensure compliance with state and federal laws
• Manage and oversee section and initiative budgets, in collaboration with the finance team
• Manage and oversee authorization and review processes for non-Medicaid benefits, SUD Residential services, Partial Hospitalization Programs, Crisis Stabilization Units, and Eating Disorder services
• Manage and oversee care coordination services for individuals without insurance and collaborate with Medicaid MCO’s and behavioral health treatment providers on care coordination activities for King County residents
• Manage the BHRD client services phone line
• Facilitate and manage a King County Integrated Care Network (KCICN) Clinical Providers meeting
• Manage daily operations to include overseeing project activities, assessing issues and risk, scheduling and allocating resources, budgeting, and ensuring timely and accurate completion of project assignments
• Oversee and develop care coordination activities, supports, and technology tools or platforms, including design, implementation, and continuous quality improvement
• Responsible for adherence to National Quality Assurance Commission (NCQA), Centers for Medicaid/Medicare (CMS), Health Care Authority (HCA), and Managed Care Organization (MCO) utilization management requirements, including the development of policies and procedures, data and reporting systems, and job aides to conduct utilization management & medical necessity reviews in compliance with State Medicaid requirements
• Prepare/coordinate the development of reports, Requests for Proposals (RFP's), Requests for Information (RFI's), as needed
• Oversee all contract deliverables in local, state, and federal grants and oversight of contracts or legislatively directed policy changes that relate to the delivery of care coordination services or execution of medical necessity requirements
• Participate in statewide and local advocacy for policies and initiatives that further effective behavioral health care coordination and treatment utilization
• Engage and collaborate with key system partners on care coordination and utilization management efforts, including Medicaid MCO's and treatment providers across the behavioral health continuum
• Implement data-driven Continuous Quality Improvement practices to drive further improvements in utilization management and care coordination within the King County behavioral health system
• Lead efforts to adopt evidence-based practices and effective technology solutions to improve care coordination and utilization management
• Track budget, site visits, evaluations/performance measures, and use of evaluation to make midstream updates and redirections
• Respond to requests from and represent the county in meetings with King County Executive's Office and Council, state staff, and other elected officials on issues affecting BHRD programs and services
• Coordinate and collaborate with BHRD sections and external partners to optimize section activities
• Perform other related duties as assigned.

Benefits

• Employees will be provided with a County-issued laptop and must maintain a home workspace with an internet connection where they can reliably perform work and remain available and responsive during scheduled work hours.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager