UM Clinical Services Director in New York, NY at Beacon Health Options

Date Posted: 1/6/2020

Job Snapshot

Job Description

About the Position:

Beacon Health Options is seeking a dynamic Clinical Services Director to join our Utilization Management team in Manhattan, NY or remotely! The Clinical Director is responsible for daily operations of the Clinical department, this includes Utilization Management of inpatient and outpatient services and Case Management Services. The Director will ensure policies and procedures are developed meeting all regulatory standards including NCQA, URAC and state requirements and will interface with MVP meeting all deliverables as required by contract. The director will work with the Medical Director and other team members to ensure all Clinical initiatives involving providers and the build out of clinical services are executed as necessary to service all lines of business.

Position Responsibilities:

  • Providing direct clinical and administrative supervision to Clinical Departments.
  • Resolves problems within the UM, CM processes working closely with other departments to ensure all reviews are completed. Ensures complaints, grievances, peer reviews and appeals involving clinical are resolved.
  • Meets with providers, and other directors to develop a system of care meeting the needs of members.
  • Working with the Medical Director to identify and resolve complex clinical issues related to clinical assessment, referral, and case management.
  • Maintaining daily, weekly, and monthly departmental productivity and utilization statistics;
  • Attends the Utilization Management Committee and the Quality Management committee and its sub-committees. Presenting all MVP clinical data as necessary
  • Collaborating with Vice President, Medical Director, Quality Director, Clinical staff to identify policy and procedure development needs;
  • Ensuring that the department meets or exceeds departmental and account specific performance standards as well as accreditation expectations;
  • Collaborating and consulting with the Vice President regarding the operations budget;
  • Working with other departments to resolve issues related to assessment, referral, and case management, as needed;
  • Participating in the Request for proposal process, site visits and new account implementations as required
  • Ensures all department needs/deliverables are met
  • Performing other duties as assigned.

Position Requirements:

  • Education: B.S. Degree in mental health field or an Associate’s Degree in Nursing with related psychiatric nursing experience required
  • Licensures: Current, valid and unrestricted license in a mental health field (RN, Ph.D., LCSW/LMSW, LMHC, LPC, etc.) in the state of New York is required
  • Relevant Work Experience: 5 – 7 years of clinical operations leadership experience in the delivery of behavioral health/substance abuse treatment services required
  • Knowledge, Skills 7 Abilities:
    • Knowledge of Public Sector/ Medicaid benefits preferred
    • Outstanding leadership and coaching skills required
    • Demonstrated ability to work collaboratively (both internally and externally) required

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

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