UM Clinical Director - Tri State / Mid Atlantic Region in New York, NY at Beacon Health Options

Date Posted: 7/11/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Clinical Director to join our team at our office in Manhattan, NY!  The Director will be responsible for responsible for behavioral health utilization management for Beacon’s NY-based health plan partners as well as network behavioral health providers. This individual provides technical assistance and monitoring of behavioral health clinical staff and provider agencies as it relates to utilization management and review. This position ensures that Beacon’s policies and procedures comply with NYS requirements and support effective utilization management including protection against under- and over-utilization for Beacon’s health plan partners.

Position Responsibilities:

  • Develops and implements the annual Utilization Management Plan, Utilization Management Work Plan and conducting the UM Plan Evaluation
  • Submits of the Utilization Management Plan, Utilization Management Work Plan and Evaluation of the Utilization Management Plan to the Medical Management Committee for approval within contracted time frames
  • Develops and implements policies and procedures to effectively manage utilization in accordance with NYS requirements and contractual requirements
  • Develops, implements, and monitors corrective action plans in conjunction with recommendation on the part of the behavioral health UM subcommittee, corporate committees, Medical Director and Program Director
  • Reports behavioral health utilization management trends to the BH UM subcommittee for the health plan and Beacon’s corporate committees
  • Provides clinical input into educational programs, consultation, public forums, public awareness and professional workshops/seminars
  • Supports clinical program development and implementation activities
  • Collaborates to identify and manage strategic market specific clinical innovation with providers, members, and health plans
  • Collaborates with high volume, strategic providers to improve service delivery quality and to initiate new services to ensure a robust continuum of care is available to members served
  • Uses established benchmarks to monitor, track, and trend aggregated, product specific and plan specific utilization and care management metrics. Uses this information in meetings with clinical managers, who are accountable for the performance of their team.
  • Consults periodically with practitioners through attendance at professional meetings and conferences as well as through membership on various committees (i.e., BH UM subcommittee, Provider Advisory, Clinical Management) to which practitioners are invited

Position Requirements:

  • Education: Master’s degree in a behavioral health discipline required
  • Licensure:  Current, valid, unrestricted licensed clinician in a behavioral health discipline (e.g., APRN, LPC, LCSW, LMFT, RN) required
  • Relevant Work Experience:  3 supervisory experience in utilization management for behavioral health services or more than 5 years’ experience in utilization management of behavioral health services in a managed care or clinical setting. 
  • Knowledge, Skills & Abilities:
    • Experience working with community and family-based services recommended
    • Knowledge of NYS child-serving systems required
    • Excellent communication/negotiation skills (i.e., verbal and in writing)
    • Knowledge of DSM-IV/5
    • Ability to manage and coordinate with internal and external departments
    • Must be detail oriented; able to work independently in a changing environment

To Apply:

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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