UM Clinical Services Supervisor - West Region in Cypress, CA at Beacon Health Options

Date Posted: 11/6/2018

Job Snapshot

Job Description

About The Position:

We are currently seeking a dynamic UM Clinical Services Supervisor to join our team in Cypress, CA! The Outpatient UM Clinical Services Supervisor is responsible for screening, triaging, and assessing members to determine appropriate level of care based on medical necessity criteria. Responsible for outpatient utilization management and monitoring activities of mental health services provided in outpatient care settings, and supervision of outpatient Clinical Case Managers.

Position Responsibilities:

  • Supervise day-to-day duties of the clinical outpatient call center.
  • Monitor individual staff and aggregate department performance to ensure all customer, accreditation and regulatory standards are met.
  • Interface with members, counties, providers to problem solve, answer questions and provide benefit information.
  • Responsible for hiring and training of new employees.
  • Responsible for employee evaluations, disciplinary procedures and terminations as indicated, in accordance with company policies.
  • Remain aware of payer contract requirements and company policies and procedures and updates clinical staff.
  • Conducts monthly staff meetings in coordination with Department Director.
  • Provides annual training to clinicians on timeliness standard, application of level of care criteria and review UM policies and procedure.
  • Provides ongoing training and training materials for clinicians and evaluating, developing and implementing workflows.
  • Responsible for completing quarterly chart audits of clinicians and IRR’s assisting with the application of level of care criteria.
  • Responsible for clinician work schedules, including lunches and breaks and paid time off.
  • Actively monitors screening triage and UM activities to ensure timeliness.
  • Responsible for completing and reporting monthly performance data on screening triage and UM activities.
  • Comply with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards.
  • Attend and participate in CMC meetings and other meetings as assigned by Director of Outpatient Services.
  • Monitor staff compliance with mandatory trainings.
  • Monitor completion of UM denial and authorization letters.
  • Adheres to all Beacon policies and procedures and standards of operations.
  • Completes all required and assigned trainings.
  • Performs annual staff reviews and establish individual/team goals for development.
  • Motivates team members to reach department goals and objectives.
  • Attends all mandatory company or department meetings.
  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Acts as a mentor to team members by leading by example and guiding with a sense of integrity and team work.
  • Meets regularly with team members for one on ones and staff meetings.
  • Identifies opportunities for staff improvement, high performing team members, and training needs of team members.
  • Partners with management to identify areas of opportunity within department and makes improvements on processes, culture, or work environment.
  • Acts as a liaison between staff, management, and other functional departments for consistent improvements of functions and work flow.
  • Identify misconduct and finds resolution and escalate to Human Resources.
  • Travel to all company sponsored events, trainings, and locations based on business needs.
  • Performs special projects and other duties as assigned and required.
  • Telecommuting an option

Position Requirements:

  • Education: Bachelor of Science in Nursing (BSN) or master’s degree in mental health related discipline required
  • Licenses: Current, valid and unrestricted independent licensure (LCSW, LMFT, LPCC, RN, Ph.D. or PsyD.) for practice required with proof on date of hire required. 
    • Re-verification will take place no less than every three (3) years.
  • Relevant Work Experience: 2 years experience as a supervisor in healthcare related field or clinical oversight with management responsibilities including but not limited to hiring, performance management, and training required
  • Knowledge, Skills, & Abilities:
    • Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information for the purposes of care management and coordination.
    • Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills.
    • Clinicians are required to be educated in current principles, procedures of behavior health care.  Managed care and state specific expertise and knowledge of community resources experience preferred.

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