Manager, Clinical - Mltc

Gee-Gee DFW Jobs New York , NY 10007

Posted 6 months ago

Position Purpose: Manage Case Management and Care Coordination services and activities for members with co occurring behavioral health and medical conditions. Manage clinical team of licensed medical and behavioral health clinicians.

• Manage clinical services including oversight of clinical policies and procedures and daily activities of integrated care coordination team staff.
• Ensure adequate staffing to conduct case management activities and effectively distribute workloads.
• Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities including chronic physical and behavioral health conditions.
• Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to ensure compliance.
• 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.
• Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for members.
• Ensure appropriate case planning, education and interventions are conducted for members defined to be at risk.
• Ensure staff coordinate exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members.
• Monitor data to address quality measures, trends or potential improvement opportunities including provider issues, service gaps and member needs.


Education/Experience: Bachelor’s degree in Behavioral Health or related field or Graduate from an Accredited School of Nursing. 3+ years case and/or utilization management experience. Thorough knowledge in assessment, diagnosis, treatment of individuals with serious mental health or substance abuse disorders, case management, mental health community resources and local health delivery systems. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

License/Certification: LCSW, LMFT or LPC, or a PhD, PsyD or RN license in applicable state. Independent license required.

For Specialty Therapy: Bachelor’s degree in the area of specialty (Speech, Occupational, or Physical) or related field. 5+ years of specialty therapy or utilization management experience. Thorough knowledge of a specialized or technical field such as case and/or utilization management, including application of basic theory. Knowledge of utilization review procedures and familiarity with educational services.

License/Certification: Current license in area of specialty (Speech, Occupational, or Physical) in applicable state.

For Fidelis Care only: NYS unrestricted license as Registered Nurse (RN), Foreign Medical Graduate (FMG) or Licensed Practical Nurse (LPN)

• Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
• Employee Status:
• Regular
• Job Level:
• Manager
• Job Type:
• Regular

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Manager, Clinical - Mltc

Gee-Gee DFW Jobs