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AVP Clinical Management

Company: Beacon Health Options
Location: New York
Posted on: September 14, 2019

Job Description:

Beacon Health OptionsJob Category: Clinical - GeneralReq #: AVPCL01428Schedule: Full TimeLocation: NY - ManhattanBeacon is currently seeking anAVP Clinical Management to join our team in the tri-state area.Must have valid, unrestricted NY mental/behavioral license.TheAVP of Clinical Management is responsible for the direction and leadership of a performance driven care management program including the on-going monitoring of operational performance and workforce management; the development, management and implementation of clinical programs and operations; regional provider strategy performance improvement; client issues; management of medical loss ratio issues; focus on continuous performance improvement; and the monitoring of utilization data and trends in the assigned region. This position will have oversight of the operational non-clinical and clinical teams ensuring all systems are in place to meet regulatory, client and clinical best practicesWhat does a typical day look like?Oversee regional CM programs, including utilization, complex case management, intensive case management, care coordination, and case consultationManage and monitor the Aftercare program including monitoring performance against internal as well as contractual (SLAs, PG) goals and collection of Non Standard Supplemental Data (NSSD)In collaboration with internal and external stakeholders build sustainable integration programs and activitiesLead annual production of UM/CM/QM Regional Trilogy Documents, including monitoring work plan activity completionDirect the implementation of the Regional Provider Quality and monitor outcomesDirect and oversee regional clinical and service quality programs led by the Regional Quality leadDevelop Regional SOPs to support Corporate wide clinical, quality, and provider strategy policies when neededTrain/coach team members on corporate, market, and regulatory developments that impact their roles and functionsEnsure that team members are updated on changes in policies and procedures that impact their operationsUnder the direction of Corporate Quality, ensure compliance with NCQA MBHO and URAC standards and contractual requirementsEnsure adequate participation in Corporate Quality Committees, specifically Corporate Quality Committee, Corporate Medical Management Committee, Corporate Utilization Management/Care Management CommitteeChair or assign designee for regional clinical, quality and provider Strategy team meetingsOversee and Assign team members to implement new clinical programs, new client implementations assuring all deliverables for clinical, quality and provider partnerships are metWork with the account team, the CMO and the growth officer in the region ensuring client clinical and quality requirements are met.Monitor client clinical and quality CAPs and PGs for the region(OPS)Collaborate with proposals and sales on new business development opportunities for supporting regional growth.Represent Regional Clinical, Quality, and Provider Strategy on cross regional business development opportunitiesAct as a liaison in URAC and NCQA accreditation and certification activities with Beacon's Quality Team including: continuous monitoring for standard compliance, document retention and retention of certification and accreditation.Responsible for ensuring that the operations of the regional clinical team are aligned to support the regions MLR and clinical quality targets. Collaborate with Legal on compliance activities for clinical operations to ensure we are maintaining all contractual, legal and accreditation requirementsParticipate in customer meetings as needed and development and implementation of new business, including contract reviews, proposal requests, sales presentations, and RFP reviewsWork with the VP of Clinical Management to identify necessary changes in clinical algorithms to ensure appropriate authorizations are being automated; oversee algorithm adjustments and the operational processes to ensure their accuracyMonitor, analyze, and report on trending of utilization data, working with the Regional Chief Operating Officer (RCOO), Regional Chief Financial Officer (RCFO) and VP Clinical Management to recommend targets; to assess performance against established targets; and to facilitate effective interventions where variance from UM targets may be identified locally or regionallyEnsure that performance metrics across all clinical, quality, and provider quality are accurately and consistently monitoredMaintain a pro-active quality and process improvement program with in line with corporate policies, procedures and protocols, auditing mechanisms and data reporting systemsIn collaboration with Corporate Quality and other regional center, proactively identify areas requiring performance improvement, and collaborate with stakeholders to develop improvement activitiesContinuously monitor utilization management productivity and other operational metrics for region; identify issues related to changes in productivity; direct and oversee appropriate interventions to manage productivity to targetsContinuously monitor processes and procedures and develop recommendations to create efficiencies; direct and oversee recommended changes to processes and systemsEnsure successful completion of all internal and external accreditation, delegation, compliance, and legal auditsOversee implementation of new clinical business, products, and specialty programs (e.g. Here For You)Oversee and Monitor Key Performance IndicatorsQuantitativeClient satisfaction with clinical quality performance (e.g. HEDIS BH Measures, STARS)Client satisfaction with Beacon's collaboration and integration activitiesImproved HEDIS BH Measure performanceRegional Member and Provider SatisfactionSuccessful completion of client auditsMeeting and PGs/SLAs and monitoring/completing CAPsQualitativeChampion of executing against new clinical reporting structureChampion of performance improvement and the CQI processCollaborate with UM functional area, Reporting and Analytics, and Finance for client contracts, including implementation and tracking of targeted intervention strategies and pricing/target feedbackCollaborate with Clinical Quality Standards lead on annual update of clinical policies and procedures, level of care criteria and selection of clinical practice guidelinesCollaborate with Ops Pod Leaders to develop effective and efficient processes to interface with Ops Pods to solution a range of client and other clinical, quality and operational issuesEffective partnering with UM Shared Services, Ops Pods, etc.Employee Management/DevelopmentTalent Development and CoachingManagement of Budgetary expectationOversight and delineation of staffing ratios and expectationsProvision of trainingWhat you Contribute?Education: The position requires a minimum of a Master's Degree in a related field (healthcare administration, behavioral sciences etc.) or RN with equivalent experience.Licensure:Current, valid and unrestricted licensure required with proof on date of hire. Re-verification will take place no less than every 3 years.RelevantExperience: 7-10 years managed behavioral healthcare or related experience. This includes leadership experience in utilization management practices and principles, management of Medical loss Ratio, clinical services, quality management practices and principles, NCQA and/or URAC accreditation and HEDIS measures. The candidate must have a strong customer service orientation, excellent written and verbal communication skills, and experience using management information systems. Knowledge and experience related to clinical services will be beneficial. Senior-level experience with operations and UM; fluency in clinical operations and driving operational efficiencies while managing resulting impacts to MLR; and understanding of regulatory and accreditation requirements necessary.Knowledge, Skills & Abilities:Leadership skills and supervisory experience, including the ability to develop team performanceExcellent written and oral communication skillsSelf-motivated, able to prioritize multiple issues, excellent organizational skills, ability to track multiple projects/tasks and follow through as needed.Knowledge of NCQA and URAC standards and accreditation processKnowledge of HEDIS BH measuresCQI tools and techniquesAbility to manage and coordinate with internal and external departmentsAbility to manage staff in operations environmentDemonstrated leadership skills and experience, including the ability to work cross-functionally, build consensus and develop staffAbility to manage time-sensitive projects and meet deadlinesAbility to identify opportunities for improvements and recommend and implement innovative solutions.Able to work collaboratively with internal staff and external providers/clientsMust be detail oriented; able to work independently in an ever changing environmentMust have excellent communication and negotiation skills.What Makes Us Different?Here, it's not just a job - it's an opportunity to change lives.Our employees are learners, innovators and originalOur mission and values guide the way we treat our members, providers and each other.What We Have to Offer:Healthcare benefits available starting day 1!Health & well-being incentives, such as gym membership reimbursement401K with company match to help reach your future financial goalsGenerous PTO, because we know life happens outside of workTuition reimbursement so you can keep reaching your fullest potentialIf Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/DisabledAt Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (). Only candidates who have applied for an open position through our Careers page () will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.#GD#CBPM16#LI-DC1PI113567836Pandologic. Keywords: Psychiatric Nurse, Location: New York, NY - 10001

Keywords: Beacon Health Options, New York , AVP Clinical Management, Executive , New York, New York

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