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UM Clinical Assistant Vice President (AVP) - Horizon in Newark, NJ at Beacon Health Options

Date Posted: 12/5/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Clinical Assistant Vice President (AVP) to join our team at our office in Newark, NJ!  The UM Clinical AVP is responsible for clinical oversight of utilization management and case management activities throughout the service center’s NJ offices and contracts. The primary focus of this position is to ensure that the delivery of quality clinical care and service to health plan members meets NCQA, URAC, and state, federal and contractual requirements. The AVP works in collaboration with the other service center operational units to ensure the clinical operational needs of the organization are met.  Regional Clinical directors will report into the AVP.

* This position is based in Newark, NJ with travel once a week to Mt. Laurel, NJ*

Position Responsibilities:

  • Clinical oversight of all utilization management and case management operations across the NJ offices and contracts.
  • Oversight of the development of and adherence with organizational and state specific UM and CM policies and procedures.
  • In collaboration with Clinical Directors monitors the census across all NJ commercial lines of business and Medicare.  Provides monthly updates to VP of Client Partnerships.
  • Provides direction to the Clinical Directors on program metric development, analysis and benchmark adoption.
  • Provides direction to plan Behavioral la Health Clinical Leaders in the reporting and analysis of plan specific UM and CM metrics.
  • In collaboration with the VP of Client Partnerships monitors utilization and case management trends and formulates strategies to manage costs.
  • Directs UM and CM programs in the development of clinical programming to improve the health outcomes of the members we serve. 
  • Represents Beacon at client meetings regarding clinical issues.
  • Resource to the Director of Quality Management and Improvement on all NCQA and URAC initiatives and readiness.         
  • Periodic consultation with practitioners in the field through attendance at site visits, professional meetings and conferences as well as through membership on various committees, i.e. Provider Advisory, Clinical Management, etc. to which practitioners are invited.
  • Participates and consults on corporate initiatives and activities as a subject matter expert.
  • Collaborates with other service centers to promote best practices.
  • Other duties as assigned.

Position Requirements:

  • Education: Master’s Degree required
  • Licensure:  Current, valid, unrestricted, and independent LCSW licensure required in the state of NJ
  • Relevant Work Experience:  8 years’ of managed care experience, in both the public sector and commercial lines of business required
  • Knowledge, Skills & Abilities:
    • Expert and proficient level of knowledge, skill and ability
    • Analytical and problem solving ability
    • Interpersonal communication skills
    • Verbal and written communication skills
    • Group presentation and public speaking skills
    • Collaboration and team-oriented work philosophy

To Apply:

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Beacon Health Strategies, LLC. a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled