Director, Clinical Services in Cypress, CA at Beacon Health Options

Date Posted: 10/22/2019

Job Snapshot

Job Description

We Help People Live their Lives to the Fullest Potential!

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a ‘world-class’ candidate experience from the moment you click ‘Apply’! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

Do you have a passion for helping others? If so, we are looking for you!

Beacon is currently seeking a Director, Clinical Services a highly organized and compassionate professional to join our team at our Cypress, CA office.  The Director, Clinical Services is responsible for clinical oversight of Utilization Management in the West Region. 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 Director, Clinical Services works in collaboration with the AVP, Clinical Services to ensure the clinical operational needs of the organization are met.

What does a typical day look like?

  • Clinical oversight of all utilization management services in the West Region
  • Participates in and oversees compliance with internal audits and external client UM audits
  • Identifies opportunities to streamline workflows that result in accurate, high quality production standards and improved results in cost savings, or outcomes measurement
  • Complete annual evaluations and program descriptions for UM programs
  • Development of custom UM reports if indicated and monitors all UM key performance indicators
  • Tracks and monitors all metrics related to UM program, implements plans for improvement as necessary
  • Collaborates and helps coordinate Peer Review process
  • Oversight of the development of and adherence with organizational and state specific UM policies and procedures
  • Monitors the census across all lines of business
  • Provides direction to Managers in the reporting and analysis of plan specific UM metrics
  • In collaboration with the AVP, Clinical monitors utilization management trends and formulates strategies to manage costs
  • Participates in new business opportunities including requests for proposals
  • Directs UM 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 AVP, Quality 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

What you Contribute?

Education: Master’s degree or higher in a health related field and independent licensure as a behavioral health professional required.

Licensure:

  • Current, valid and unrestricted licensure for practice required with proof on date of hire. Re-verification will take place no less than every 2 years.
  • Valid State Clinical License required (RN, LCSW, LMFT, PhD or PsyD)

Knowledge, Skills & Abilities:

  • 4-5 years behavioral health managed care experience preferred. Experience with financial and clinical data analysis and reporting required.
  • 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.

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 thinkers.
  • 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 & wellbeing 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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