LocationNY: Latham (10 British American Boulevard)
Job FamilyClinical, LicensedJob Brief
We are currently recruiting for a Director of Utilization Management (UM) Intake Services to join our team in Woburn, MA or Latham, NY!
ExemptAbout the Position:
We are currently recruiting for a Director of Utilization Management (UM) Intake Services
to join our team in Woburn, MA or Latham, NY! The Director is responsible for the comprehensive directives of the functions of the UM Intake Services teams including the UM Intake Coordinator teams and the Prior Authorization Utilization Review Team (PAT). Responsibilities include the oversight and management of clinical and non-clinical functions of the UM Intake Services unit supporting the UM Shared Services Department, ensuring that the Intake Coordinator and PAT teams meet productivity targets, quality standards, and customer service expectations. The position reports to the SVP, Utilization Management Strategy and Operations. Position Responsibilities:
- Oversees the daily management of the UM Intake Services unit.
- Serves as immediate resource to the Manager of Prior Authorization and Mangers of Intake Coordinators to assist with problem-solving.
- Maintains thorough knowledge of Beacon's level of care criteria and Scripted Screening process.
- Monitors utilization and call volume activity for the Prior Authorization Team and Intake Coordinator teams.
- Responsible for workforce management for both the intake coordinators and the PAT team clinicians.
- Accountable for meeting all service level agreements for all clients.
- Provides supervision to the manager of Prior Authorization Team.
- Monitors call quality metrics via quality auditing process of both calls and documentation.
- Participates in NCQA and URAC activities.
- Oversees and implements policies and procedures related to the administrative intake and PAT team functions of utilization management.
- Participates in recruitment, hiring, and retention of UM Intake and PAT management team; develops talent through training, mentoring, coaching, and ongoing evaluation including annual performance appraisals.
- Ensures team meets productively standards expectations.
- Coordination with utilization review management and regional clinical teams for appropriate escalations of provider issues, provider barriers, and performance issues.
- Responsible for weekly performance reporting to each Region for their specific clients.
- Responsible for creating and executing corrective action plans for any performance issues.
- Other duties as assigned.
- Education: M.S. degree or higher in a health related field and independent licensure as a behavioral health professional or BSN required.
- Licensure: Current, valid and unrestricted licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 3 years.
- Relevant Work Experience: 3-5 years combined direct behavioral health, supervisory and/or managed care experience required.
- Knowledge, Skills, & Abilities:
- Demonstrated ability to provide excellent customer service, including effectively communicate with potentially distressed providers.
- Ability to work with data and analytics in relation to staff performance and productivity standards.
- Demonstrated leadership skills and supervisory experience, including the ability to develop team performance.
- Self-motivated, able to prioritize multiple issues, excellent organizational skills, and able to track multiple projects/tasks and follow through as needed.
- Ability to self-manage and perform multiple tasks that require prioritization and accurate completion in an ever changing environment.
- Ability to manage, coordinate, and work collaboratively with internal and external departments as well as external providers
- Must have excellent negotiation skills
- Knowledge of phone systems and telephony workflows
- Knowledge of basic medical and behavioral health terminology
- Able to type and have knowledge of MS Office Suite (Word, Excel, PowerPoint including web based computer applications is required).
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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/Disabled
AAP Reporting Location:NY - Latham
ID (Req #):53784
FTE Status:Full Time
Schedule:Monday - Friday, 40 hours