Beacon Health Options
Job Category: Clinical – General
Req #: VPCLI02878
Schedule: Full Time
Location: AR – Little Rock
We Help People Live their Lives to the Fullest Potential!
For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a ‘world-class’ candidate experience from the moment you click ‘Apply’! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.
Do you have a passion for helping others? If so, we are looking for you!
Beacon is currently seeking an Director Clinical Services to join our team out of Little Rock, AR or surrounding area. The Director of Clinical Services is responsible for the direction and leadership of a performance driven utilization management program including the on-going monitoring of operational performance and workforce management, focus on continuous performance improvement, and the monitoring of utilization data and trends in the assigned region. This position will have oversight of the operational non-clinical and clinical teams (including subcontractors) ensuring all systems are in place to meet regulatory, client and clinical best practices. The position also has oversight of the statewide care coordination program to ensure goals of the program are met and that operational collaboration occurs. This position has a dotted line reporting relationship into the regional Chief Operating Officer (RCOO) who monitors profit and loss for the region and will look to the Director of Clinical Services to assist with market and/or provider strategy initiatives.
What does a typical day look like?
The Director of Clinical Services is responsible for ensuring the contract meets all UM performance and productivity targets. (30% time allocation) Responsibilities include:
- Continuously monitor utilization management productivity and other operational metrics for defined contract; identify issues related to changes in productivity; direct and oversee appropriate interventions to manage productivity to targets
- Supervise and oversee Utilization Management in the day-to-day operations of the UM department
- Work with the VP of clinical services to identify necessary changes in UM algorithms to ensure appropriate authorizations are being automated; oversee algorithm adjustments and the operational processes to ensure their accuracy
- Continuously monitor processes and procedures and develop recommendations to create efficiencies; direct and oversee recommended changes to processes and systems
- Ensure corporate policies are followed and local policies and processes are developed to support operations of regional units
- Maintain a pro-active quality and process improvement program with in line with corporate policies, procedures and protocols, auditing mechanisms and data reporting systems
- Assist in recruitment, training and evaluation of key UM management
- Provides oversight and direction in the development and implementation of initiatives related to utilization management and associated medical expense
- Monitor, analyze, and report on trending of utilization data, working with the Regional Chief Operating Officer (RCOO), Regional Clinical and Quality Lead (RCQL), Regional Chief Financial Officer (RCFO) and SVP UM to recommend targets; to assess performance against established targets; and to facilitate effective interventions where variance from UM targets may be identified locally or regionally
- Collaborate with Corporate Quality to understand, implement, and continuously monitor regional and company-wide quality initiatives
- Participate in regional operations and/or finance meetings where MLR and other operational initiatives are discussed that impact UM
- Collaborate with the RCQL to develop and implement processes to support effective handoffs to case management and aftercare teams
- Collaborate with the RCQL and RCOO to develop provider quality strategies and/or enhancements and changes to UM operations (i.e., algorithm changes, etc.)
- Works closely with medical director leadership and UM Shared Services Appeals and Denials team to ensure compliance with all internal and external standards and understand regional trends
- Provides oversite of statewide care coordination program including monitoring of adherence to established goals and expectations
- Ensures that protocols and policies are created in order to provide effective and efficient care coordination
- Develop programming to promote positive outcomes for the membership and collaborate with care coordination leadership on training
- Ensure the team is aligned with overall clinical program initiatives and provide mechanism for collaboration amongst teams
- Work with regional clinical leadership to ensure that recruiting and staffing is appropriate to meet needs of program
- Develop and direct appropriate workforce management protocols, as appropriate and based on client and regulatory direction
- Collaborate on the regional quality committee structure, processes and quality documentation to be in compliance with Client enterprise and customer requirements including: preparation of annual documents, development and monitoring of core performance indicators, obtainment of stakeholder input, processing of complaints and development of supportive tools and surveys.
- Oversee UM portions of delegation agreements, customer audits and compliance activities
- Act as a liaison in URAC and NCQA accreditation and certification activities with Beacon’s Quality Team including: continuous monitoring for standard compliance, document retention and retention of certification and accreditation.
- Collaborate with Legal on compliance activities for UM operations to ensure we are maintaining all contractual, legal and accreditation requirements
- Participate in customer meetings as needed and development and implementation of new business, including contract reviews, proposal requests, sales presentations, and RFP reviews
What you Contribute?
Education: Must have a master’s degree or higher or RN
License: Valid clinical license required with proof on date of hire. Re-verification will take place no less than every 3 years.
Knowledge, Skills & Abilities: A minimum of 7 to 10 years combined direct behavioral health, supervisory and/or managed care experience required. Additionally, senior-level experience with operations and UM; fluency in clinical operations and driving operational efficiencies while managing resulting impacts to MLR; and understanding of regulatory and accreditation requirements necessary.
- Excellent written and oral communication skills
- Self-motivated, able to prioritize multiple issues, excellent organizational skills and attention to detail, ability to track multiple projects/tasks and follow through as needed
- Ability to manage and coordinate with internal and external departments
- Ability to manage staff in operations environment
- Demonstrated leadership skills and experience, including the ability to work cross-functionally, build consensus and develop staff
- Ability to manage time-sensitive projects and meet deadlines
- Knowledge of CQI principles and ability to manage change
- Ability to identify opportunities for improvements and recommend and implement innovative solutions
- Able to work collaboratively with internal staff and external stakeholders (provider organizations, clients, etc.)
What Makes Us Different?
- Here, it’s not just a job – it’s an opportunity to change lives.
- Our employees are learners, innovators and original thinkers.
- Our mission and values guide the way we treat our members, providers and each other.
What We Have to Offer:
- Healthcare benefits available starting day 1!
- Health & wellbeing incentives, such as gym membership reimbursement
- 401K with company match to help reach your future financial goals
- Generous PTO, because we know life happens outside of work
If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!
Click below on “Apply for this Position” to create a profile and apply for the position
Beacon Health Options company, is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
At Beacon Health Options, our candidate’s data privacy is a top priority. Our recruiting team conducts all communications using official company email Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.
Director Clinical Services – Little Rock, Arkansas