Care Management Team Lead in Louisville, KY at Beacon Health Options

Date Posted: 9/10/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Clinical Team Lead to join our team at our office in KY.  The Clinical Team Lead) is responsible overseeing and monitoring the day-to-day workflow of the Case Management Team. S/he facilitates the delivery of the highest standards for the Case Management Program, quality outcomes and operational efficiencies, ensuring that Beacon policy and procedures are followed as well as state regulations/mandates and plan contracts. The Team Lead, in conjunction with the Director of Care Management, will identify training needs, assist the Account Partnership team in reaching contractual goals, and support the organizational goals of customer service, efficient time management, organizational competency and value added case management.

Position Responsibilities:

  • The Clinical Team Lead provides direct supervision to a team of Case Managers, including performance reviews, establishing goals/responsibilities, scheduling and time off requests.

  • Draws upon CMSA, NCQA accreditation standards, referral criteria, engagement strategies, outcomes and clinical expertise to manage all aspects of the Case Management process

  • Troubleshoots issues and submits recommendations to the Director of Care Management.

  • Anticipates the resolution of issues through proactive and effective communication.

  • Reviews Case Management data and discusses trends with the Director of Care Management.

  • Possesses and maintains an in-depth knowledge of workflows, products, program components including Foster Care, Adult Guardianship and field based CM initiatives.

  • Assists with the design, development, modification, of workflows for the Case Management Team, including triage of members for case management services.

  • Monitors progress on CM initiatives (e.g. engagement, aftercare, integration) to ensure business goals are met in compliance with Beacon policies and procedures.

  • S/he is available to the health plan for consultation on primary medical members when issues with regards to behavioral health management or treatment arise.

  • Facilitates clinical policy implementation and maintenance, assesses training and development needs, and identifies clinical resources and tools to improve program effectiveness and quality.

  • Responsible for maintaining accurate information in Beacon’s and the Health Plan’s clinical documentation systems as directed.

  • Identifies, assesses, and holistically manages complex behavioral health cases for those members who are in the dual eligible program.

  • When delegated, oversees activities associated with reporting to the plan, the State, and/or other agencies and providers.

  • Completes quarterly audits of case managers’ work within FlexCare as outlined by the established audit tools.

  • Utilizes the evidence based guides to identify problem areas

  • Provides case consultation and guidance for case management episodes and events

  • Arranges for case presentations during internal and integrated rounds.

  • 5-10% local travel

    Position Requirements:

  • Master’s Degree in behavioral health field or Bachelor’s Degree in nursing. Have either:

    A current, valid, unrestricted independent license in behavioral health field (including LCSW, LPCC, LMFT)

  • If supervising the Case Management process for three (3) years or more, it is highly desirable that s/he hold a certification as a case manager.

Relevant Work Experience:  

  • A minimum of 3-5 years combined direct behavioral health, supervisory and/or managed care experience required.

  • Knowledge of medical necessity criteria and treatment protocols for psychiatric and chemical dependency diagnoses.

  • Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.

  • Must have knowledge of both the UR and CM function to serve as needed as a support for workloads managing cases.

  • Provides team management that demonstrates a supportive environment, clear expectations, coaching and accountability for team performance.

Knowledge, Skills & Abilities:

  • Excellent computer skills

  • Strong analytical and problem solving skills

  • Strong written and verbal communication skills

  • Detail oriented and able to work independently

  • Supervisory experience

TO APPLY

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

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

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