WellSense Health Plan · 18 hours ago
Senior Manager of Care Management, Behavioral Health Director of BH Programs and Strategy
Boston, MA
Full-time
Hybrid
Senior Level, Lead/Staff, Director/Executive
$96K/yr - $140K/yr
5+ years expWellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for our members. The Senior Manager of Care Management, Behavioral Health is responsible for coordinating and managing BH care management processes, collaborating on strategies to meet behavioral health quality goals, and communicating with state regulators and stakeholders.
Hospital & Health Care
No H1B
Responsibilities
Leads the development and implementation of clinical operations initiatives including policies and procedures, care coordination, workflow plans, intensive clinical management, activities to support quality initiatives across all products and other clinical areas as appropriate
At the direction of the Director of BH Programs and Strategy, independently leads new behavioral health program development and implementation
Serves as the BH care management subject matter expert for the health plan
Works collaboratively with clinical, quality and medical staff on clinical program development in behavioral health as appropriate
Leads and supports standardization of integrated health plan clinical processes across clinical areas and teams
Collaborates with other department managers and the BH material subcontractor in the planning, development and coordination of department specific and cross-functional initiatives
Ensures Behavioral Health care management (CM) staff has resources and systems necessary to complete job functions, and that information is documented and communicated to staff via written operational policies, procedures and related workflows
Works collaboratively with health plan clinical teams and other stakeholders on clinical program issues
Works collaboratively with health plan clinical teams, BH medical staff, BH material subcontractor and other entities as appropriate on resolution of escalated member issues, to include leading state regulatory prescribed efforts related to member transition of care due to provider terminations
Works collaboratively with medical care management senior leadership across the BMC Health System as required and appropriate as well as other WellSense departments and providers to ensure the integration of BH and other programs and services
Along with BH leadership, coordinates information to EOHHS and DHHS, other state regulators and stakeholders as appropriate to demonstrate program performance and meeting member needs
Participates and works with BH senior leadership as appropriate in the recruitment, orientation, management, supervision and training of staff
Assists senior behavioral health management staff and the BH material subcontractor in ensuring the success of clinical network quality improvement initiatives
Provides high level of service and satisfaction to internal and external customers
Attendance is an essential function of the position
Perform other duties as assigned
Qualification
Required
Master's degree in a behavioral health field such as psychology, social work or a degree in nursing is required
Minimum five to seven years' experience managing staff in a behavioral healthcare organization required
Current certificate or state licensure in Massachusetts and New Hampshire as RN, LICSW, LMHC, Clinical Nurse Specialist, or Licensed Psychologist
Able to work in a fast paced environment; ability to multi-task
Proven leadership skills and ability to build effective teams and ability to work collaboratively with management staff in other departments
Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications
Strong clinical problem solving skills
Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting
Detail oriented and excellent analytical skills
Ability to work both independently and as part of a team
Strong oral and written communication skills; ability to interact within all levels of the organization
Preferred
Clinical supervisory experience with a Medicaid managed care population preferred
Benefits
Medical
Dental
Vision
Pharmacy
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family wellbeing
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
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