Manager, Behavioral Health (Outpatient) UM & Programs

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality affordable healthcare. Serving nearly 2 million members Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. Weve had a long-standing commitment to inclusion and equal healthcare access and outcomes regardless of background; its at the core of who we are. We value the rich mix of backgrounds perspectives and experiences of all of our colleagues which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve live and work.

We enjoy the important work we do every day in service to our members partners colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Job Description

• Manage daily operations including but not limited to the assignment and distribution of work among assigned Behavioral Health Utilization Management team(s). Ensure all workflow processes are completed within the required timeframes and telephone coverage requirements are met. Ensure adherence to all department and regulatory standards.
• Serve as member of Behavioral Health leadership team. Provide back-up for peers including supervisory coverage. Partner with peers to ensure effective cross-functional end to end approach to meet the needs of members providers and internal and external stakeholders.
• Support and help drive efforts to integrate Behavioral Health into the broader Tufts Health landscape by providing a cohesive behavioral health presence and subject matter expertise to Public Plans and Enterprise activities including case management medical management and provider/network management.
• Under the direction of the Director of Behavioral Health develop implement and manage initiatives and projects to achieve Tufts Health Public Plans goals. Collaborate with internal departments in support of clinical activities and operations.
• Manager of Childrens Behavioral Health Initiative (CBHI) team completes extensive network management activities in coordination with MassHealth and other MCOs/ACOs.
• Develop and prepare reports to meet internal regulatory contractual and accreditation requirements. Work closely with other departments in the development of report specifications and obtain data for and/or complete reports as needed to meet contract and regulatory requirements and track ongoing data.
• Hire train and manage staff. Supervise/coach staff to assist them in attaining optimal knowledge and job efficiency. Define metrics and goals for assigned team(s) and manage expectations. Utilize data to monitor and evaluate individual team and program performance. Provide timely feedback to all staff regarding their performance via regular team and one-on-one meetings. Conduct formal performance appraisals. Take appropriate disciplinary action in a timely manner when needed. Ensure staff is provided with all necessary tools resources and training to promote growth and performance within the department and/or organization.
• Monitor utilization management and ensure servicing goals are met or exceeded by tracking department metrics. Apply data utilize evidence-based treatment practices and identify opportunities for improvement of quality of care and medical expense savings to design implement and enhance utilization management and clinical care coordination processes. Track and monitor the impact of utilization management and care coordination on quality and medical expense measures.
• Complete monthly clinician case review audits and review semi-annual IRR results to monitor UM decision making and adherence to policies and procedures. Identify trends develop and implement action plans for improvement progress
• Provide monthly Care Management report on team(s) performance metrics and goal achievement to the Director of Behavioral Health.
• Review and develop department policies procedures workflows and job aids as needed consistent with departmental and company strategic objectives and mission. Develop maintain update orientation materials in collaboration with clinical trainer.
• Work collaboratively on and manage components of quality improvement initiatives and medical expense reduction activities and ensure alignment with broader company strategy. This includes activities that support NCQA accreditation and identify and promote best practices within clinical programs.
• Provide information and support to internal stakeholders. Work collaboratively with other managed care entities MassHealth the Executive Office of Health & Human Services as well as provider and other stakeholder groups.
• Other duties and projects as assigned.
  

Salary Range

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors including the scope and complexity of the role; the skills education training credentials and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program colleagues are also eligible for variable pay. Eligibility for any bonus commission benefits or any other form of compensation andbenefits remains in the Companys sole discretion and maybe modified at the Companys sole discretion consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development individual & family health and financial health

For more details on our total rewards programs visit welcome all
All applicants are welcome and will receive consideration for employment without regard to race color religion gender gender identity or expression sexual orientation national origin genetics disability age or veteran status.

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