Manager, Integrated Care Management - Behavioral Health

Under the direction of the Director, the Clinical Manager “Manager” oversees the performance of the interdisciplinary team in the delivery of care management for all members enrolled in the Plans’ care management program. The Manager ensures that the delivery of care management and related care coordination activity is based on established protocols, policies, procedures, practice standards and applicable contract and model of care requirements. The Manager provides day to day oversight of team practice and ensures appropriate delegation of responsibilities based on scope of practice standards and staff credentials. The Manager provides leadership and direction to staff assigned and ensures that resources are prioritized and allocated based on member needs and acuity level. Based on assigned responsibility and based on the Product, the Manager may oversee behavioral health care managers, Senior Care Manager- BH, coordinators, and peer specialists. The Manager represents Care Management at internal and external committees/forums as directed by the Director. The Manager engages in clinical quality initiatives, including case reviews, chart audits, trainings and manages measures associated with key performance indicators. The Manager develops and maintains positive relationships with all members of the clinical team within the Plans’ Care Management, including physician leaders. The Manager promotes a positive practice environment and advances team-based learning and member management.

• Identifies utilization risks and medical trend management opportunities
• In collaboration with the UM Manager, Medical Directors, and Clinical Manager peers, assesses utilization drivers in complex members
  • Identifies utilization risks and medical trend management opportunities
  • Identifies members for rounds and leads the rounds process
  • Actively engages in medical trend management opportunities
• Identifies members for rounds and leads the rounds process
• Leads or engages in performance improvement initiatives
• Other duties and projects as assigned.
• Supervises clinical and support staff and acts as a medical resource to behavioral health clinical staff and managers to ensure practice standards that support care management are met
  • Monitors staff productivity and balances staffing accordingly
  • Provides feedback and coaching to Care Management staff. Promotes staff development, goal setting and job effectiveness. Leads or engages in performance improvement initiatives. Takes appropriate disciplinary action in a timely manner in accordance with Point32Health’s Human Resources policies and procedures.
• Supports various improvement projects thru data collection and analysis
• Oversees adherence to Model of Care compliance, including audit readiness activities
• Works with peers to monitor and analyze member attrition and improvement follow-up
• Provides feedback and coaching to Care Management staff. Promotes staff development, goal setting and job effectiveness. Leads or engages in performance improvement initiatives. Takes appropriate disciplinary action in a timely manner in accordance with Point32Health’s Human Resources policies and procedures.
• Serves as a member of improvement team
• Ensures all care management policies and procedures are reviewed and recommends revisions
• Engages in the preparation of monthly, quarterly, and annual reports as delegated by the Director
• Monitors compliance with clinical documentation
• Monitors staff productivity and balances staffing accordingly
• Follows up on member grievance and critical incident investigations
• Participates in quality improvement initiatives
  • Supports various improvement projects thru data collection and analysis
  • Follows up on member grievance and critical incident investigations
  • Serves as a member of improvement team
  • Works with peers to monitor and analyze member attrition and improvement follow-up
  • Leads or engages in performance improvement initiatives
• Under the direction of the Director, ensures clinical practice supports contract and regulatory compliance
  • Monitors compliance with clinical documentation
  • Oversees adherence to Model of Care compliance, including audit readiness activities
  • Ensures all care management policies and procedures are reviewed and recommends revisions
  • Partners with Compliance staff and oversees audit prep activity
  • Engages in the preparation of monthly, quarterly, and annual reports as delegated by the Director
• Actively engages in medical trend management opportunities
• Partners with Compliance staff and oversees audit prep activity

• Current license to practice in Massachusetts without restriction
• LICSW, LMHC, LMFT, RN or Licensed Psychologist.
• Maintains active profession-specific license in good standing without restrictions
• Master’s degree in Behavioral Health, Nursing, and/or business or related healthcare field, or Doctorate in Psychology

• Expertise in operations management and process redesign
• Experience in customer service practice required
• Demonstrable experience in data management and measurement, including continuous quality improvement practice
• Working knowledge of clinical practice development and cross functional team-based practice
• Minimum of 5 years’ experience in a clinical leadership role
• Working knowledge of regulatory compliance practice and monitoring activities
• Five to seven years’ experience in a managed care setting required

• Work cooperatively as a business partner across multiple levels within the organization
• Utilize a continuous process improvement approach to evaluate and influence interdepartmental end to end processes that assure administrative efficiency, member satisfaction, and that compliance requirements are met.
• Results orientation – strives to meet business goals including metric driven targets.
• Influencing others – particularly those outside of direct reporting relationships. Ability to lead and motivate team of direct reports to achieve quality and volume metric targets.
• Strong communications skills (formal and informal, written and verbal). Ability to effectively communicate with members and internal / external business partners & stakeholders via written correspondence (e.g., e-mail, letters, presentations); and verbally in a clear and professional manner that both meets the needs of the audience and represents the Plan and / or department positively.
• Critical and Analytic thinking – must understand cause and effect, internal and external impact of business changes and THP information systems. Able to assess staff performance and team operations to problem-solve, drive continuous process improvement, and achieve desired outcomes.

• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.
• Must be able to work under normal office conditions and work from home as required.