Manager, Clinical Program -Behavioral Health Utilization Management

Location: This position is located at our Dublin, OH campus.

Who weare

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Manager, Clinical Program – Behavioral Health Utilization Management (BH UM) is responsible for supporting the Director, Clinical Program – Behavioral Health in providing clinical leadership to the BH UM team. This individual works in partnership with the Director and the clinical team to ensure consistency of clinical activities within Quantum Health’s BH UM program and to support the mission and core values of the organization.

What you’ll do

• Recruiting and retention, including supporting new hire selection
• Direct management of behavioral health clinicians and support staff
• Deliver performance feedback. Responsible for performance management / coaching support to clinical staff to develop team and maximize success of employees
• Support and model community-like culture within the team to recognize and reward innovation that improves our member and employee satisfaction
• Oversee the assimilation of new clinical and support team members and ensures continuous development via skill building and refresher training programs as well as quality monitoring process
• Conduct 1 on 1 meetings and quarterly check in/review conversations with all assigned clinicians leveraging data provided by cross-functional teams
• Lead the succession planning and IDP process for employees to ensure continued professional development and delivers the feedback for high potential employees
• Facilitate clinical huddles to ensure collaboration with workload and case needs
• Lead content creation and facilitation of team meetings in partnership with their leadership
• Support maintaining a culture of camaraderie, partnership and collaboration
• Ensure accountability and shared responsibility for providing high-quality member and provider support
• Maintain effective relationships with our clients and communicates information with respect to client expectations
• Responsible for partnership with external plan partners including Third Party Administrators (TPA), Pharmacy Benefits Managers (PBM), and Vendor Partners to ensure support for the client's plan and members on immediate issues or concerns
• Identify and resolve problems to ensure client and member service is maintained at the highest level and communicate any trends to Pod leadership for escalation
• Partner with leadership to ensure effective client implementation and keeping the Client Executive aware of issues/trends
• Participate as a Clinical Leader in prospective/current client site visits
• Provide clinical support to Pod leadership and CEG teams for escalated client cases
• Serve as the key clinical leader in advocacy and clinical audits through presentation of material, answering questions, recapping themes needing addressed in partnership with the Director of Clinical Quality and Accreditation, Clinical Trainers, Clinical Program Leadership, Clinical Delivery Leadership, and Pod Leadership
• Serves as an Expert Resource
• Reinforces expectations regarding process, protocol, program design
• Accessible to staff to answer questions and clarify expectations, as needed
• Assist with resolving escalations and complex challenges
• Communicates information with respect to client expectations, business results/metrics, member satisfaction and team culture
• Provide clinical specialty team support including: triage PSR (Patient Service Representative) questions and provide clinical guidance as indicated, triage clinical questions and resolve/delegate appropriately, be available as clinical resource/support for leadership and specialty team staff
• Monitor and adjust daily clinical workload within the team
• Maintain a working knowledge of all clinical workflows and policies
• Responsible for helping team members get answers to questions, resolution to issues, and support for action to help improve the member’s healthcare journey
• Other duties as assigned

What you’ll bring

• Licenses:Active license as a Registered Nurse in the State of Ohio
• Minimum 2 years of Behavioral Health experience
• 3 - 5 years of experience preferred managing a Behavioral Health team
• Experience mentoring and/or coaching in a clinical setting
• Excellent verbal and written communication skills
• Proven ability to deliver results in a high-service healthcare or insurance environment (preferably a fast-paced, service based, efficiency driven background)
• Diverse knowledge base of role and function of all nursing functions within the department
• Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
• A high degree of personal accountability and trustworthiness, a commitment to working within Quantum Health’s policies, values and ethics, and to protecting the sensitive data entrusted to us.

#LI- HW #LI-Onsite