Manager, Clinical

» Manager, Clinical
Healthcare
in Chicago
, IL
Reference: 19-03328

Position Purpose:

  • Manage clinical services to include management of clinical services, marketing of clinical services and supervision of clinical staff
  • Manage clinical services including oversight of clinical policies and procedures, day to day clinical services and staff
  • Ensure compliance with established initial and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes
  • Ensure all programs and clinical operations are in full compliance with state and federal regulations including HIPAA
  • Ensure compliance with plan’s emergency management policies, procedures and processes by acting as liaison with other business units
  • Ensure payer contract clinical deliverables are met
  • Monitor the effectiveness of existing procedures and outreach/intervention efforts
  • Ensure appropriate knowledge/education and interventions are conducted for members defined to be at risk
  • Monitor data to address trends or potential quality improvement opportunities including provider issues, service gaps, member needs

Additional Responsibilities:

  • Oversee the implementation and maintenance of the provider training program for community agencies
  • Collaborate with network development team to track and analyze needs and recommend training plans
  • Act as liaison with provider and community agencies, including state hospital facilities, Community Mental Health Centers (CMHC) and various providers, foster care system and community organizations

Education/Experience:

  • Master’s degree in behavioral health or RN required
  • 3-5 years case and/or utilization management
  • Thorough knowledge in assessment, diagnosis and treatment of individuals with general mental health or substance abuse disorders
  • Knowledge of utilization review procedures, case management and familiarity with mental health community resources
  • 2-3 years supervisory experience preferred

Knowledge/Experience:

  • Master’s degree in Behavioral Health or related field or RN license required
  • 8+ years of case and/or utilization management experience, including demonstrated experience both in the provision of direct care services as well as progressively increasing levels of management responsibilities, with a particular focus on direct care and administrative responsibilities within community mental health services

Licenses/Certifications For Both Roles:

  • LCSW, LMFT or LPC, or a PhD, PsyD or RN license in applicable state
  • Independent certification by the State Board of Behavioral Health Examiners required