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Director, Behavioral Health, Health Plans
1 month ago
New York, New York, United States VNS Health Full timeOverviewDirects plans, evaluates, and coordinates Behavioral Health and Social Care needs for multiple lines of business including HIV-SNP -HCBS/HARP, MAP, MAPD, and DSNP Plans.Demonstrates a commitment to delivering high-quality, personalized Behavioral Health services, placing member needs and recovery goals at the forefront of all...
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Bilingual Lead Clinician
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Behavioral Health Clinician
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Facilities Operations Manager
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Behavioral Health Pediatric Navigator
1 month ago
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Behavioral Health Pediatric Navigator
3 weeks ago
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Behavioral Health Pediatric Navigator
2 weeks ago
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Child/Adolescent Behavioral Health Clinician
2 months ago
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Lead Clinician
2 months ago
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Creative Comms Lead
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Clinician
1 month ago
New York, United States Vibrant Emotional Health Full timePosition: Clinician Location: New York, NY 10001 Job Id: 2155 # of Openings: 2 Position Title: Clinician Department: Youth & Family Wellness Services Reports to: Program Director Location: In-person, Queens, Manhattan and the...
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Clinician
1 month ago
New York, United States Vibrant Emotional Health Full timePosition: Clinician Location: New York, NY 10001 Job Id: 2155 # of Openings: 2 Position Title: Clinician Department: Youth & Family Wellness Services Reports to: Program Director Location: In-person, Queens, Manhattan and the...
BH UM Clinician Team Lead
2 months ago
MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The Behavioral Health Utilization Management (BH UM) Clinician Team Lead provides oversight of the administration of departmental utilization management activities.The BH UM Clinician Team Lead will act as the liaison between the medical and Behavioral Health UM and Case Management teams and work together with the other Medical Management Leadership to manage the department. The BH UM Clinician Team Lead is expected to promote and facilitate a multidisciplinary approach to coordinate care, while also ensuring adherence to standards of care consistent with current professional regulations of the company.
Job Description
- Supervise the Behavioral Health Utilization Management Clinicians for Utilization Reviews and monitoring
- Supervise the Behavioral Health Utilization Management Appeals Clinician
- Monitor BH UM Clinician performance, identify opportunities for efficiencies and work with staff closely to close any found deficiencies
- Oversee utilization review activities and ensures cases are reviewed timely meeting NYS DOH. OMH, OASAS and CMS regulatory standards
- Support Utilization Management team development through direct staff training and development activities
- Conduct utilization review and quality of care monitoring activities in conjunction with BH Care Management Program staff
- Review and monitor quarterly audits of clinical staff's work with Care-Connect
- Review denial letters submitted by all UM staff for content and accuracy
- Assist with developing new workflows for UM and policy changes on applicable regulatory guidelines
- Investigation and resolution of clinical claims related issues
- Support departmental training and clinical quality improvement activities
- Participate in the development, implementation, and evaluation of performance improvement initiatives and other related projects within UM
- Ensure that standards of care delivery are consistent with current professional standards and consistent with the Mission, Vision, and Values of the organization
- Actively participate in Article 44/49 and CMS audit activities
- Participate in committees, as assigned.
- Assist all MetroPlusHealth departments with the resolution of the members issues related to BH UM
- Master's Degree required
- Post graduate clinical experience 6-8 years required with at least 3 years previous managed care experience. Ideally 2 years specific to Behavioral Health/HARP Knowledge of BH Medical Necessity Criteria (OMH/OASAS)
- Prior supervisory, training or management experience preferred. (2-4) years
- Superior Technical Computer skills (Microsoft Office, Excel, Care Connect, Teams Video Application)
- Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH)
- Demonstrated ability to manage large caseloads in a fast-paced environment while building and enhancing team productivity
- Demonstrated professionalism and leadership skills along with the ability to develop, direct and support staff
- LCSW, LMSW, or LMHC unrestricted active New York State License
- Integrity and Trust
- Teamwork and Problem-Solving Attitude
- Customer Focus
- Functional/Technical Skills
- Excellent written and oral communication skills required. Ability to multi-task well.
- Ability to work in a fast-paced environment
- High degree of diplomacy and tact
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