Job Information
Healthfirst Director, Clinical Operations Children's Services in United States
Duties/Responsibilities:
Provides leadership and directs the home and community-based services (HCBS) and case management program of the Childrens Services unit for Healthfirst members ages 0-21.
Participates in all aspects of the teams management and employee lifecycle to ensure appropriate talent management.
Ensures a team atmosphere that fosters open communication, collaboration, ownership, and empowerment to make decisions
Ensures guidelines as mandated by CMS and NY State regulations, job aides, and HF policies are followed. This includes review of individual and aggregated CM performance audit results in order to maintain superior and accurate care data for each HF member
Participates actively in strategic planning for BH department clinical operations including special projects and pilots
Represents Healthfirst at city and state meetings, external presentations, and provider forums to educate and build collaborative relationships
Oversees childrens behavioral health initiatives and direction that support safe, aggressive treatment resulting in quality outcomes and cost-effective care
Addresses issues identified by internal risk assurance functions including but not limited to fair hearing process, SIU, etc.
Demonstrates proficiency in reviewing and analyzing utilization and productivity data and flexibility in managing to report results
Uses data to optimize BH Care Management department integration and operations including workflows; policies and procedures; utilization management practices; and quality monitoring
Identifies key improvements that will advance operations and further the seamless integration of the behavioral health and general medical teams
Performs other duties as assigned
Minimum Qualifications:
Bachelors degree from an accredited institution
Current License/Certification as Behavioral Health Professional, such as Psychologist, Social Worker or Licensed Mental Health Counselor (i.e., LCSW, LMHC, LMSW, PhD, PsyD.)
Seven years of experience in a BH managed care setting or BH clinical setting, including at least two years of managed care experience (preferably Medicaid managed care) and at least five years of experience working with children
Demonstrated effectiveness with written and oral communication
Demonstrated effectiveness of interpersonal skills and the ability to work effectively at all levels in a collaborative team environment
Preferred Qualifications:
Masters degree from an accredited institution
Knowledge of the various child serving systems in NYS
Knowledge of NYS Medicaid Program
Experience in strategic development and operational management in a managed care organization with a focus in Behavioral Health
Prior work experience in education
Experience with clinical operations, clinical quality, quality assurance and/or project management
Experience working with high performing, cross functional teams
Sound organizational skills with the ability to handle multiple tasks and prioritize appropriately
Flexible, adaptable, and excellent problem-solving skills with a proven track record for driving results
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.