Clinical Operations Manager in Boston, MA at Beacon Health Options

Date Posted: 10/6/2019

Job Snapshot

Job Description

Beacon is currently seeking a Clinical Operations Manager to join our team at our Boston, MA office!

The Clinical Operations Manager reports directly to the Director of Clinical Operations (QOD) to provide clinical, operational, and inter-departmental support, as well as, coordinate the functions of the regional clinical teams supporting all regional contracts.  In collaboration with the COD, the COM supports, oversees and participates in clinical implementation activities, yearly revisions to medical necessity criteria, policies and procedures and other related clinical documents.

What does a typical day look like?

  • Assists in the clinical operation management of the Region, serves as an expert resource and facilitates clinical operations engagement between functional units i.e. Aftercare, Quality, Provider Quality, and the Care Management pods.
  • In collaboration with the COD and Corporate Quality Accreditation, ensure ongoing compliance with accreditation (NCQA and URAC) standards.
  • Responsible for assisting with new client implementations (inclusive of new services on existing client) for clinical and quality components.
  • Lead on clinical & quality aspects of audits collaborating with corporate quality accreditation (internal audits), Ops Pod and account partnerships as needed.
  • Ensures contractual and delegation agreement compliance for the Region.
  • Project manages cross-department initiatives within the Region, and across Shared UM Services
  • Assists in the development of contractual reporting requirements as needed.
  • Acts as a liaison between CQO, Ops Pods, Shared UM Services, and Care Management to maintain operational procedures and updates.
  • Leads Clinical Management initiatives to support Clinical Review and Care Management teams.
  • Leads cross regional teams to ensure adherence with accreditation, compliance and other contractual requirements. Activities may include workflow development, system enhancement, measurement review, and process improvement.
  • Proposes clinical and/or quality solutions to business issues/problems utilizing appropriate analytic tools and business processes to ensure quality, cost effectiveness, timelines, with awareness of contractual and regulatory requirements/mandates.
  • Works with the Regional Quality Director and team to coordinate quality control on clinical and quality deliverables, implementations and ad hoc requests.
  • Lead representative in cross-departmental Regional meetings to support accreditation. (i.e., QIC, UM/CMC).
  • Participate in external account meetings (BHOC, JOC, etc.).

What you Contribute?

Education: Minimum of a Master’s degree in related field (healthcare administration, behavioral sciences, business, project management) required.

Licensure: Current, valid and unrestricted licensure in mental/behavioral health (LCSW, LPC, LMFT, LMHC or RN etc.)

Work Experience:

  • A minimum of 5-7 years combined direct behavioral health, supervisory and/or managed care experience required.
  • Preferably five years managed behavioral healthcare or related experience
  • A working knowledge of account management, customer relations and business management are essential
  • The candidate must have a strong customer service orientation, excellent written and verbal communication skills, and experience using management information systems
  • Knowledge and experience related to clinical services will be beneficial

Knowledge, Skills & Abilities:

  • Leadership skills and supervisory experience, including the ability to develop team performance
  • Excellent written and oral communication skills; excellent negotiation skills
  • Self-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.
  • Demonstrated understanding of CQI - knowledge of principles and ability to manage change
  • Ability to manage and coordinate with internal and external departments
  • Demonstrated leadership and management skills and experience, including the ability to work cross-functionally, build consensus and develop staff
  • Ability to manage time-sensitive projects and meet deadlines
  • Ability to identify opportunities for improvements and recommend and implement innovative solutions.
  • Able to work collaboratively with internal staff and external providers/clients
  • Must be detail oriented; able to work independently in an ever changing environment

What Makes Us Different?

  • Here, it’s not just a job – it’s an opportunity to change lives.
  • Our employees are learners, innovators and original
  • Our mission and values guide the way we treat our members, providers and each other.

What We Have to Offer:

  • Healthcare benefits available starting day 1!
  • Health & well-being incentives, such as gym membership reimbursement
  • 401K with company match to help reach your future financial goals
  • Generous PTO, because we know life happens outside of work
  • Tuition reimbursement so you can keep reaching your fullest potential

If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

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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