Behavioral Health Operations Manager
2 days ago
Join CenCal Health as a Behavioral Health Operations Manager and take on a challenging role that requires strategic thinking, leadership, and a passion for improving healthcare outcomes.
Job SummaryThe Behavioral Health Operations Manager is responsible for planning, organizing, and managing the daily operations of the Behavioral Health (BH) Utilization Management (UM) and Care Coordination team. This role involves inventory management, meeting key performance indicators, and regulatory requirements. The successful candidate will contribute to maintaining up-to-date program descriptions, policies, and procedures, participate in special assignments, audits, and focus projects, and perform related work as assigned.
Key Responsibilities- Plan, develop, and oversee Behavioral Health (BH) Utilization Management (UM) and Care Coordination team functions and activities.
- Create controls to monitor and track key performance indicators.
- Manage inventory, productivity, and staffing to ensure key performance indicators are met, as well as regulatory requirements.
- Create staffing models, productivity, and quality standards for team functions.
- In collaboration with the Master Clinical Trainer, identify training and efficiency opportunities.
- Create and update Policies and Procedures in support of UM and Care Coordination functions.
- Review and optimize workflows to support efficient and effective processes.
- In collaboration with the Director of Behavioral Health, ensure the appropriate and timely use of Utilization Management criteria and guidelines and medical policy in the administration of treatment to CenCal Health members.
- Support the Behavioral Health Department staff that report directly to the Behavioral Health Operations Manager with specialized knowledge of chronic co-morbid condition management, care integration, transitions, referral management, and all other aspects of care management and care coordination as it relates to mental and behavioral health.
- Participate in internal and external audits.
- Participate in State Fair Hearings as requested.
- Analyze and prepare regular reports of BH Utilization Management and Care Coordination activities.
- Collaborate with Information Technology (IT) in the development of electronic health records, functionality, and reports.
- Provide guidance to providers and members related to timely request, authorization requirements, etc.
- Internal meetings leading solutions-oriented approach to improve transitions of care, coordination, and healthcare delivery system.
- Act as a liaison to internal and external customers for prompt resolution of issues.
- Provide input for projects and programs within the Health Services Department.
- Ensure unit meets all departmental, regulatory, and contractual compliance goals.
- Attend County and other external meetings as assigned.
- Facilitate monthly/as needed provider training on behalf of the department-including creating content.
- Monitor staff productivity and compliance.
- Serve on agency committees.
- Other duties as assigned.
CenCal Health is seeking a highly skilled and experienced Behavioral Health Operations Manager to join our team. The ideal candidate will have a strong background in managed care, healthcare operations, and leadership. The following qualifications are required:
- Knowledge of current principles and practice of managed care and health plan regulatory requirements as it applies to assigned unit.
- Ability to effectively collaborate with internal and external customers.
- Ability to drive performance and compliance with regulatory requirements.
- Ability to plan, direct, and coordinate activities for a large number of direct reports and staff.
- Able to mentor and assist in the development of staff, leads, and supervisors.
- Able to mentor and counsel low performers.
- Take a leadership role to initiate activities, communication, and projects.
- Prepare accurate records and reports in a timely manner.
- Effective verbal and written communication skills; and presentation skills.
- Proficient computer skills in Word, Excel, Outlook, and PowerPoint.
- Knowledge of Utilization Management and case management standards of practice requirements as it relates to health plan activities.
- Administrative Practices and Procedures knowledge as it relates to utilization review, peer review, policies, and standards related to managed care, and quality/regulatory aspects.
- Experience developing and maintaining a budget.
- Experience designing and implementing Programs/Teams.
- Experience in case management or care coordination.
The following qualifications are preferred:
- Managed health care experience.
- Experience reviewing Behavioral Health Therapy (BHT) and Applied Behavior Analysis (ABA) authorizations.
- Experience utilizing Milliman Clinical Guidelines (MCG).
CenCal Health is an equal opportunity employer and welcomes applications from qualified candidates. The ideal candidate will have a current, active, and unrestricted California license as a R.N., LCSW, LMFT, or LPCC, and a minimum of 2 years of experience in a supervisory position in a managed care setting or county behavioral health.
CenCal Health is a dynamic and growing organization that is committed to improving the health and well-being of our members. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.
If you are a motivated and experienced professional who is passionate about improving healthcare outcomes, we encourage you to apply for this exciting opportunity.
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