Dec 14, 2019
WellCare Health Plans
Organization: Health Services Reports to: State President Location: 432 North 44th Street Phoenix, AZ 85008 Creates and drives behavioral health services that are provided to members. Plans, coordinates and manages overall behavioral health services in a dedicated WellCare state/region, including clinical operations, provider identification, negotiation, contracting and service functions. Leads the day-to-day operations for behavioral health inpatient and outpatient utilization and/or case management activities with focus on achieving quality and service driven objectives. Oversees regulatory compliance with laws, regulations and policies that govern behavioral health aspects of the business. Acts as the behavioral health leadership representative for the state/region. Essential Functions: Drives behavioral health programs through the development of policy and procedure, clinical criteria, workflows and other behavioral health documentation. Monitors processes and procedures to ensure compliance with contractual, regulatory (Federal/state) and accreditation entities. Provides leadership and support to front-line staff and supervises. Provides guidance to Behavioral health management for future expansion and growth efforts. Coordinates quality assurance and quality improvement activities with regional and corporate departments. Assists with development of member and provider education tools and materials. Assists with development of clinically-focused training associated with behavioral health assessment, care plan development and behavioral health services in the state. Assists in establishing effective operational practices and works closely with various health plan departments and regulatory agencies to ensure contracts meet operating, financial and legal standards. Performs data analysis and develops specific actions to manage medical cost trends. Establishes, maintains and fosters professional working relationships with all behavioral health providers and develops regular ongoing working relationship with the community mental health system in the market including community mental health centers, treatment facilities and other significant behavioral health providers. Partners and collaborates with other departments and the corporate office regarding behavioral health matters and initiatives. Oversees the day-to-day operations for behavioral health associates which include activities designed to achieve quality of work products and outcomes of individual performers. Serves as a community liaison and leader for community advisory boards, advocacy groups, task forces or other community-based stakeholder activities. Performs other duties as assigned. Additional Responsibilities: Support the integration of physical, behavioral, and social services in the systems of care provided to adult members (Arizona) Ensures timely delivery of required reporting to the State (Arizona) Takes the lead and serves as the face of the health plan for the AZ Health Care Cost Containment System (AHCCCS) (Arizona) Candidate Education: Required A Master's Degree in Social Work, Psychology, Counseling, Rehabilitation, or other relevant field that provides a foundation to receive a license as required of the position Required Other or Registered Nurse with behavioral health background Candidate Experience: Required 8 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning Required 5 years of management experience Required 4 years of experience in a managed care environment (as a licensed mental health professional) Candidate Skills: Advanced Knowledge of healthcare delivery Advanced Demonstrated interpersonal/verbal communication skills Advanced Ability to create, review and interpret treatment plans Advanced Ability to effectively present information and respond to questions from families, members, and providers Advanced Ability to effectively present information and respond to questions from peers and management Advanced Ability to lead/manage others Advanced Ability to influence internal and external constituents Advanced Ability to multi-task Intermediate Demonstrated analytical skills Intermediate Demonstrated written communication skills Intermediate Ability to work in a fast paced environment with changing priorities Advanced Demonstrated organizational skills Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records Ability to analyze and interpret financial data in order to coordinate the preparation of financial records Licenses and Certifications:
A license in one of the following is required: Required Other One of the following is required: Required Licensed Clinical Mental Health Counselor (LCMHC) Required Acute Care Nurse Practitioner (APRN) (ACNP-BC) Required Licensed Registered Nurse (RN) Required Licensed Clinical Social Worker (LCSW) Required Licensed Clinical Marriage & Family Therapist (LCMFT) Required Licensed Clinical Professional Counselor (LCPC) Required Licensed Clinical Psychologist (LCP) Required Other In Missouri, a Master's degree and one of the following licenses is required: Mental Health Clinical Nurse Specialist, Mental Health Nurse Practitioner, or a Missouri licensed Psychologist. Technical Skills: Required Intermediate Microsoft Word Required Intermediate Microsoft Outlook Required Intermediate Microsoft Excel Preferred Intermediate Microsoft Access Required Intermediate Healthcare Management Systems (Generic) Required Intermediate Financial Management Systems (Generic) Languages: About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Professional Diversity Network
Phoenix, AZ, USA