Utilization Management Clinical Supervisor, Behavioral Health
We’re seeking Utilization Management Clinical Supervisor to join our behavioral health team! In this role, you will work to promote the well-being of our members by assessing, collaborating with providers, monitoring and coordinating care.
Be a part of a mission driven company and work alongside passionate, caring and collaborative team members. If you are motivated to make a difference in people’s lives and want to play a role in transforming how healthcare is delivered, we invite you to check out the opportunity below and apply today.
The UM Clinical Supervisor, Behavioral Health is responsible for daily supervision and the ongoing operations of the Behavioral Health (BH) inpatient and outpatient Utilization Management (UM) program. She /He works closely with the Behavioral Health Clinical Operations Manager, providers and contracted entities. Functions as a liaison between providers, clinicians and Plan staff in coordinating the integration of Behavioral and Medical Management. In the capacity of utilization review the Behavioral Health UM Clinician Supervisor functions as a liaison between BMCHP inpatient and diversionary BH providers related to the authorization processes, continued stay decisions, discharge planning and transitions of care.
– Supervises, trains and coaches BH Utilization Management Clinicians.
– Reviews performance and ensures adherence to departmental policies and procedures.
– Monitors staff work assignments and makes appropriate adjustments based on staffing levels, and number/ types of authorization requests received.
– Ensures clinical staff document clinical assessments and coordination of care in the medical management information system in a timely manner that meets regulatory and accreditation standards.
– Authorizes and evaluates appropriate BH services with providers for inpatient and diversionary levels of care utilizing approved medical necessity criteria.
– Conducts quality audits and shares results in a timely manner with staff, providing necessary education and counseling to improve performance.
– Participates in process reviews and the development of new and/or revised work processes, policies and procedures relating to utilization review.
– Conducts utilization reviews (prior authorization, concurrent review and discharge planning) of all BH levels of care through the application of BMCHP approved BH criteria to determine medical necessity and equitable administration of benefits.
– Works collaboratively with BH medical staff on comorbid admissions and discharge planning.
– Acts as liaison with outside entities, including physicians, hospitals, social service agencies and regulatory agencies.
– Manages a limited caseload if of inpatient admissions.
– Establishes and maintains positive communication and creates an environment that fosters teamwork, cooperation and respect.
– Assists senior behavioral health management staff in ensuring the success of clinical quality improvement initiatives.
– Provides high level of service and satisfaction to internal and external customers.
– After hours availability as needed.
– Regular and reliable attendance is an essential function of the position.
– Perform other duties as assigned.
– Degree in a behavioral health field such as psychology or social work, or a degree in nursing required.
– 4 years to 7 years related experience in Mental Health, Utilization Management, and/or substance abuse treatment including 1-3 years prior supervisory experience required.
– Experience with Medicaid recipients and community services.
– Clinical supervisory experience with a managed care population preferred.
– Experience with prior-authorization, utilization review, and/or discharge planning.
– Experience in a health plan or insurance environment.
– Experience with InterQual or other clinical policy criteria.
Certification or Conditions of Employment:
– Current certificate or state licensure as an RN, LICSW, LMHC, Clinical Nurse Specialist, Licensed Psychologist or CADAC is required.
Competencies, Skills, and Attributes:
– Able to work in a fast paced environment; ability to multi-task.
– Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications.
– Strong clinical problem solving skills.
– Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting.
– Detail oriented and excellent analytical skills.
– Ability to work both independently and as part of a team.
– Strong oral and written communication skills; ability to interact within all levels of the organization.
Working Conditions and Physical Effort:
– Travel to hospitals and other provider locations may be required.