Mgr Clinical Services

Less than 5 years experience  •  Data Storage

Salary depends on experience
Posted on 10/10/17
Less than 5 years experience
Data Storage
Salary depends on experience
Posted on 10/10/17

We are currently seeking a dynamic Manager of Clinical Services to

Position Responsibilities:

  • Oversight of the day-to-day Clinical operations and staff providing Clinical Services: denials, appeals, and production of letter generation to ensure compliance with all State, Federal, Plan rules, URAC and NCQA requirements.

  • Provides direct supervision and administrative oversight of Clinical Care Managers, including timekeeping and annual reviews

  • Conduct periodic clinical audits; Assist with client and accreditation audit preparation and presentations.

  • Insure High level of audit ready clinical cases for plan account as well as lead all prep activities for regular clinical audits.  

  • Works closely with Director of Clinical Services and AVP of clinical Operations to ensure clinical processes and procedures are in alignment with regulations and accreditation standards within each department.

  • Responsible for clinical criteria updates, clinical policy and procedure review to ensure compliance with Beacon Corporate Clinical, State, client, regulatory and accreditation standards.

  • Assists Director of Clinical Services with clinical implementation.

  • During implementations coordinates with hiring manager on ensuring infrastructure and training is in place for new hires.

  • Facilitates weekly staff meeting and clinical case conferences.

  • Understands the clinical team’s standard operating procedures and works with the clinical team to develop clinical training materials, (job aides, FAQs, etc.) as needed.

  • Works closely with Director of Clinical Services in the development of clinical models and workflow and other operational clinical functions (new and existing business).

  • Provides assistance with clinical system enhancement request, testing and training.

  • Knowledge of benefit procedures codes and collaborates with business solutions, system configuration, business architecture, and claims on adjudication logic development.

  • Collaborates with Business Intelligence with development of clinical reporting requirements.

  • Ability to Travel as needed

  • Other duties as assigned

      Position Requirements:

    Education: Master’s degree or higher in a health related field

Licensure:  Independent licensure as a behavioral health professional required.

  • Valid State Clinical License required (RN, LCSW, LMFT, PhD or PsyD)

  • Current, valid and unrestricted licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 3years.

Knowledge and Abilities

  • The ideal candidate will be organized, creative, and have strong verbal and written communication skills and will be experienced in managing cross-functional/cross-departmental priorities.

  • Experience with Behavioral Health Utilization Review, Case Management and technical operations in a managed care setting is preferred.

  • Strong background operations management and supervisory experiencepreferred

  • Project Management experiencepreferred

  • Self-motivated, able to effectively prioritize in a fast paced environment

  • Can-do attitude and ability to work collaboratively with internal staff and external partners

    Job ID:52176

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