Job ID: 52176
Location: Oak Brook, IL
Experience: Not Specified
Education: See Requirements
ABOUT THE POSITION
We are currently seeking a dynamic Manager of Clinical Services to join our team at our office in Oak Brooke, Illinois. The Manager of Clinical Services works closely with the Program Director; Director of Clinical Services and AVP of Clinical Operations to ensure the clinical processes and procedures are in alignment with client expectations, clinical corporate, regulations and accreditation standards. Including compliance, clinical criteria and policy review, training, implementations and data analysis.
Oversight of the day-to-day Clinical operations and staff providing Clinical Services: denials, appeals, and production of letter generation to ensure compliance with all State, Federal, Plan rules, URAC and NCQA requirements.
Provides direct supervision and administrative oversight of Clinical Care Managers, including timekeeping and annual reviews
Conduct periodic clinical audits; Assist with client and accreditation audit preparation and presentations.
Insure High level of audit ready clinical cases for plan account as well as lead all prep activities for regular clinical audits.
Works closely with Director of Clinical Services and AVP of clinical Operations to ensure clinical processes and procedures are in alignment with regulations and accreditation standards within each department.
Responsible for clinical criteria updates, clinical policy and procedure review to ensure compliance with Beacon Corporate Clinical, State, client, regulatory and accreditation standards.
Assists Director of Clinical Services with clinical implementation.
During implementations coordinates with hiring manager on ensuring infrastructure and training is in place for new hires.
Facilitates weekly staff meeting and clinical case conferences.
Understands the clinical team’s standard operating procedures and works with the clinical team to develop clinical training materials, (job aides, FAQs, etc.) as needed.
Works closely with Director of Clinical Services in the development of clinical models and workflow and other operational clinical functions (new and existing business).
Provides assistance with clinical system enhancement request, testing and training.
Knowledge of benefit procedures codes and collaborates with business solutions, system configuration, business architecture, and claims on adjudication logic development.
Collaborates with Business Intelligence with development of clinical reporting requirements.
Ability to Travel as needed
Other duties as assigned
Education: Master’s degree or higher in a health related field
Licensure: Independent licensure as a behavioral health professional required.
Valid State Clinical License required (RN, LCSW, LMFT, PhD or PsyD)
Current, valid and unrestricted licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 3 years.
Knowledge and Abilities
The ideal candidate will be organized, creative, and have strong verbal and written communication skills and will be experienced in managing cross-functional/cross-departmental priorities.
Experience with Behavioral Health Utilization Review, Case Management and technical operations in a managed care setting is preferred.
Strong background operations management and supervisory experience preferred
Project Management experience preferred
Self-motivated, able to effectively prioritize in a fast paced environment
Can-do attitude and ability to work collaboratively with internal staff and external partners
Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled