UM Clinical Manager - Federal Division in Cypress, CA at Beacon Health Options

Date Posted: 9/11/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic UM Clinical Manager to join our team in Cypress, CA!  The UM Clinical Manager works closely with the UM Clinical Director and the VP of UM to ensure the service centers clinical processes and procedures are in alignment with client expectations, clinical corporate, regulations and accreditation standards. The Director of Clinical Services assisting with operational management including compliance, clinical criteria and policy review, training, implementations and data analysis.

Position Responsibilities:

  • Oversight of the day-to-day operations and staff in the Clinical Services Department: denials & appeals, letter generation, clinical correspondence, data analytic support and clinical training.
  • Works closely with Director of Clinical Services and VP of UM to ensure clinical processes and procedures are in alignment with regulations and accreditation standards within each department.
  • Oversight of denials, appeals, and production of letter generation to ensure compliance with all State, Federal, Plan rules, URAC and NCQA requirements.  Conduct periodic audits of correspondence in production to ensure continued compliance standards are being met.
  • Responsible for clinical criteria updates, clinical policy and procedure review to ensure compliance with Beacon Corporate Clinical, State, client, regulatory and accreditation standards.
  • Assist Clinical Directors with client and accreditation audit preparation and presentations.
  • Assists Director of Clinical Services with clinical implementation.
  • During implementations coordinates with hiring manager on ensuring infrastructure and training is in place for new hires.   
  • Understands the clinical team’s standard operating procedures and works with the clinical team to develop clinical training materials, (job aides, FAQs, etc.) as needed.
  • Works closely with Director of Clinical Services in the development of clinical models and workflow and other operational clinical functions (new and existing business).
  • Provides assistance with clinical system enhancement request, testing and training.
  • Knowledge of benefit procedures codes and collaborates with business solutions, system configuration, business architecture, and claims on adjudication logic development.
  • Collaborates with Business Intelligence with development of clinical reporting requirements.
  • Ability to Travel as needed
  • Other duties as assigned

Position Requirements:

  • Education: Master’s Degree or higher in a health related field required
  • Licensure: Current, valid, unrestricted CA State Clinical License required (RN, LCSW, LMFT, PhD or PsyD) with proof on date of hire, re-verification will take place no less than every 3 years
  • Relevant Work Experience: experience with Behavioral Health Utilization Review, Case Management and technical operations in a managed care setting is required
  • Knowledge, Skills, & Abilities:
    • Strong background in operations management and supervisory experience preferred
    • Experience in managing cross-functional/cross-departmental priorities preferred
    • Project Management experience preferred
    • Strong verbal and written communication skills required
    • Self-motivated, able to effectively prioritize in a fast-paced environment required
    • Ability to work collaboratively with internal staff and external partners 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