Clinical Services Manager

1 week ago


Boston, Massachusetts, United States Elevance Health Full time
Job Summary

We are seeking a highly skilled Clinical Services Manager to join our team at Elevance Health. As a key member of our leadership team, you will be responsible for managing the clinical operations department and ensuring the delivery of high-quality care management, clinical utilization, and referral services.

Key Responsibilities
  • Manage the clinical operations department, including the delivery of quality care management, clinical utilization, and referral services.
  • Review medical appropriateness of psychiatric/substance abuse cases, utilizing professional knowledge to apply criteria and render certification decisions.
  • Identify areas for quality improvement and implement QI activities.
  • Interface with internal and external customers to ensure optimal quality of service.
  • Act as a liaison with other operations departments.
  • Monitor departmental compliance with all performance standards, legal, and regulatory requirements.
  • Maintain updated workflows based on current policies and procedures.
  • Participate in quality, regulatory, and account-specific meetings.
  • Responsible for departmental reporting.
  • Hire, train, coach, counsel, and evaluate performance of direct reports.
Requirements
  • Requires BA/BS in mental health field or an AA in Nursing with related psychiatric nursing experience and minimum of 5 years of behavioral healthcare experience and minimum of 3 years managed care experience.
  • Requires current, active, unrestricted license in a mental health field as an RN, PhD, LCSW (as applicable by state law and scope of practice), MHC, LPC, etc.
Preferred Skills
  • Skilled in both verbal and written communication.
  • Strong interpersonal and communication skills.
  • Experience with phone triage in a clinical setting.
  • Deep understanding of the factors that impact a person's experiences in the mental health system.
About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs. Elevance Health operates in a Hybrid Workforce Strategy, and candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.



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