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Director of UM Care Management - Northeast Region in Boston, MA at Beacon Health Options

Date Posted: 3/11/2019

Job Snapshot

Job Description

About the Position:

Beacon Health Options is currently seeking a dynamic Director of Care Management to join our Utilization Management team in Boston, MA! The Director of Care Management will be responsible for all Care Management programs supervision and oversight for all care management programing. This includes ensuring compliance with NCQA and/or URAC standards for Case Management and Disease Management programs. Works closely with UM shared services ensuring all CM services are provided to all referrals.

Position Responsibilities:

  • Leads and supervises Care Management/Disease Management activity across assigned engagement centers/clients. Number of clients varies based on complexity.
  • Provides supervision to all case management team leads and clinical CM managers.
  • Oversees compliance with internal and client CM Audits.
  • In collaboration with the Clinical/Quality operations leads, care management staff, Shared UM Services, identify opportunities to streamline workflows that result in accurate, high quality production standards and improved results in cost savings, or outcomes measurement.
  • Complete annual evaluations on Disease Management programs, Care Management programs working with analytic team in the evaluation of regional or plan specific case management programs as required.
  • Develop materials and presentations on Programs for current customers and new business opportunities if requested.
  • Develop effective working relationships with and provide high quality service for external and internal customers.
  • Work with corporate quality, regional quality and across CM pods to ensure standardization of NCQA/URAC program requirements.
  • Work with UM shared service leadership to create process flows supporting CM program, care coordination protocols ensuring timely completion of all inquiries.
  • Attend and participate in Clinical and Quality department meetings as assigned
  • Development of custom CM reports if indicated and monitors all CM key performance indicators.
  • Tracks and monitors all metrics related to CM programing, implementing plans for improvement as necessary.
  • Meets with other CM pod leads and regions in development of programs as indicated.

Position Requirements:

  • Education: Master’s degree in Behavioral Health field required
  • Licensure:  Current, valid and unrestricted clinical licensure required with proof on date of hire required, re-verification will take place no less than every 3 years.
  • Relevant Work Experience:  5-7 years combined direct behavioral health, supervisory and/or managed care experience required

To Apply:

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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

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