Director, Clinical Operations (Behavioral Health)
Be part of the leadership team for a market expansion. Talented team and strong opportunity to make a difference in your career and in the lives of the medically underserved.
Director will oversee clinical functions in all service areas including: intensive case management (ICM), utilization review (UR), provider training and care coordination in collaboration with other senior leaders.
Director will work to manage complex behavioral health conditions as well as medical issues. Engaging community resources is essential.
Responsible for clinical initiatives and oversight to ensure processes are consistent with NCQA guidelines as well as state mandates. Ensure the clinical vision and philosophy is conveyed to all staff and supporting integration efforts through interface with Health Plan leadership teams.
• Strategically plan for market-specific infrastructure needs, innovative interventions and resource allocation
• Develop clinical initiatives and monitor ICM, UR and disease management programs to ensure appropriate metrics are in place to deliver positive outcomes.
• Develop program descriptions and evaluate programs to meet set guidelines
• Ensure clinical initiatives are consistent with NCQA and state mandates
• Interface across various business unit and corporate departments to ensure effective processes and communication strategies are utilized
Master’s degree in Behavioral Health or Registered Nurse required.
5+ years of related experience in utilization management or case management.
Licenses/Certifications: Unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN in WI