Behavioral Health Clinical Program Manager

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The BH Clinical Program Manager, reports to the Senior Manager of Behavioral Health Program Performance, working collaboratively with Behavioral Health Clinical Program and Performance teams, as well as the substance use disorder (SUD) Physician, to provide clinical oversight and programmatic guidance for SUD and mental health issues, collectively known as behavioral health (BH) issues. Supports BH initiatives to comply with state contractual obligations, regulatory requirements, and accreditation standards. Also supports mental health service delivery to ensure appropriate integration of services, and brokers communication to providers and regulators as single point of contact as appropriate. Has the ability to critically evaluate SUD programs/performance outcomes and make recommendations while working collaboratively with key stakeholders to include Health Plan leadership, organizational departments, SUD and mental health providers and regulators to meet the overall business objectives.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Responsible for consulting with provider and health plan clinical teams on BH related clinical, policy and operational issues, as well as the disposition of individual cases.

* Offers support for coordinating behavioral health services and treatment across all functional areas

* Works closely with internal stakeholders, to include the WellSense SUD Medical Director and NH Medical Director as appropriate to meet WellSense operational and administrative standards and federal and state regulatory requirements and expectations

* Represents WellSense at external stakeholder meetings, including ad hoc, and is the primary representative for WellSense NH BH services with regulators as appropriate.

* Facilitates regular meetings with SUD providers in line with regulatory requirements and departmental strategy

* Leads SUD related provider audits and subsequent reporting, responsible for turning findings into actionable interventions and educational opportunities

* Responsible for ensuring SUD provider audits are thorough, completed timely and that performance and quality improvements and all required corrective actions are developed and executed accordingly.

* Responsible for ensuring relevant SUD and mental health updates across BH providers, CMHCs and internal WellSense business areas are organized and presented to stakeholders as appropriate to contract requirements.

* Partners effectively with Clinical, Quality and Network departments and other stakeholder departments to positively impact and influence identified corporate BH quality, provider SUD-related and accreditation metrics

* Reviews and analyzes data related to quality measures and clinical interventions to monitor outcomes.

* Provides project management oversight for SUD-related inter-departmental BH care processes, including goal tracking, coordination of communication, problem solving and on-going follow-up

* Ensure integration across different departments to evaluate current performance and outcomes as appropriate and directed

* Attend meetings as indicated

* Other functions as required to support departmental activities, to include overall day to day resolution of BH operational issues, as appropriate and assigned.

Supervision Exercised:

* N/A

Supervision Received:

* General Direction is received weekly by the Senior Manager of BH Program Performance

Qualifications:

Education Required:

* Masters Licensed Alcohol and Drug Counselor (MLADC) or Licensed Mental Health Professional who is able to demonstrate experience in the treatment of Substance Use Disorder, in New Hampshire

* Licensed Mental Health Counselor, Licensed Independent Clinical Social Workers, or equivalent.

Education Preferred:

* Master's Degree in Social Work, Behavioral Health, Public Health, MHA, or related field

Experience Required:

* 5 + years behavioral health specific health care / managed care experience.

* Expertise in screening, assessments, treatment, and Recovery strategies; use of MAT; strategies for working with child welfare agencies, correctional institutions and other health and social service agencies that serve individuals with Substance Use Disorders

* Experience with Medicaid populations

Experience Preferred/Desirable:

* Experience with Medicaid recipients and community services.

* Experience in implementing clinical interventions / measuring outcomes.

* Experience with data analysis

* Experience in project development and / or health policy.

* Lean Six Sigma training

Licensure, Certification or Conditions of Employment:

* Licensed Mental Health Counselor or other applicable licensure for NH and MA preferred

* Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

* Demonstrated ability in leading/ facilitating cross functionally across the organization

* Effective collaborative and proven process improvement skills.

* Demonstrated ability to successfully plan, organize and manage high impact projects.

* Demonstrated ability to work independently and manage multiple projects simultaneously.

* Strong analytical and problem solving skills.

* Strong oral and written communication skills; ability to interact within all levels of the organization.

* A strong working knowledge of Microsoft Office products.

* Demonstrated ability to successfully plan, organize and manage projects

* Detail oriented, excellent proof reading and editing skills.

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees