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UM Clinical Services Director - Horizon

Company: Beacon Health Options
Location: Newark
Posted on: February 14, 2019

Job Description:

About The Position: Employer is currently seeking a dynamic Clinical Director to join our Utilization Management team in Newark, NJ! The Clinical Director is responsible for overseeing the development and operation of Clinical Operations functions to ensure the optimal delivery of all covered services to Horizon members and compliance with contract requirements and deliverables. Position Responsibilities:

  • Provides clinical leadership to ensure effective decision making, requiring full knowledge and application of ASAM, MNC criteria and Evidenced based treatment approaches
  • Provides supervision, education and training of care management staff and other designated staff.
  • Collaborates with members of leadership to assure that process, procedures and workflows provide the maximum in efficiency and quality of services to consumers, providers, the Client and other stakeholders.
  • Provides leadership in process improvement for designated functions, offering subject matter and technical knowledge, project management skills to drive results and achieve optimal functioning
  • Ensure that staff is adhering to approved Employer clinical policies and procedures and clinical criteria within client benefits.
  • Maintain designated operational functions in support of effective utilization management, positive customer relations and compliance with contractual/accreditation requirements.
  • Assists in accreditation activities that pertain to designated functions
  • Ensure that all administrative and utilization activities are performed in accordance with client expectations.
  • Responsible for utilization results, monitoring adherence to requirements in the contract by use of data, reporting tools, conducts variance planning and leads execution of medical action plans.
  • Work closely with claims, IT, appeals other departments, in ensuring the effectiveness of clinical management and successful systemic operations.
  • Screens and interviews staff for positions with special attention to the language and ethnic diversity, knowledge and skills needed to create a team.
  • Responsible for the daily, weekly and monthly team productivity, as well as the quality and consistency of work product, clinical reviews, phone statistics, admission data and shaping behaviors. Position Requirements:
    • Education: Master s Degree in mental health field required
    • Licensure: Current valid and unrestricted license in a mental health field (Ph. D, LMSW/LCSW, MHC, LLP, LPC, etc.) in the state of NJ required
    • Relevant Work Experience: 5-7 years of clinical operations and management experience, with at least 3-5 years in a managed care environment required To Apply: Click below on Apply for this Position to create a profile and apply for the position Beacon Health Strategies, LLC., a Employer company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled #CB #GD PM1 #LI-BH1

      Keywords: Beacon Health Options, Newark , UM Clinical Services Director - Horizon, Executive , Newark, New Jersey

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