Point32Health · 1 hour ago
Manager, Behavioral Health UM and Programs
United States
Full-time
Remote
Mid, Senior Level
$99K/yr - $148K/yrPoint32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. The Manager, Behavioral Health is responsible for leading a Behavioral Health functional team, managing team performance, and overseeing clinical processes to support the Behavioral Health department while ensuring compliance with relevant regulations and initiatives.
Health CareInsurance
Responsibilities
Manage daily operations including, but not limited to, the assignment and distribution of work among assigned Behavioral Health Utilization Management team(s). Ensure all workflow processes are completed within the required timeframes and telephone coverage requirements are met. Ensure adherence to all department and regulatory standards
Serve as member of Behavioral Health leadership team. Provide back-up for peers, including supervisory coverage. Partner with peers to ensure effective cross-functional, end to end approach to meet the needs of members, providers, and internal and external stakeholders
Support and help drive efforts to integrate Behavioral Health into the broader Tufts Health landscape by providing a cohesive behavioral health presence and subject matter expertise to Public Plans and Enterprise activities including case management, medical management, and provider/network management
Under the direction of the Director of Behavioral Health, develop, implement and manage initiatives and projects to achieve Tufts Health Public Plans goals. Collaborate with internal departments in support of clinical activities and operations
Manager of Children’s Behavioral Health Initiative (CBHI) team completes extensive network management activities in coordination with MassHealth and other MCOs/ACOs
Develop and prepare reports to meet internal, regulatory, contractual and accreditation requirements. Work closely with other departments in the development of report specifications and obtain data for and/or complete reports as needed to meet contract and regulatory requirements and track ongoing data
Hire, train, and manage staff. Supervise/coach staff to assist them in attaining optimal knowledge and job efficiency. Define metrics and goals for assigned team(s) and manage expectations. Utilize data to monitor and evaluate individual, team and program performance. Provide timely feedback to all staff regarding their performance via regular team and one-on-one meetings. Conduct formal performance appraisals. Take appropriate disciplinary action in a timely manner when needed. Ensure staff is provided with all necessary tools, resources and training to promote growth and performance within the department and/or organization
Monitor utilization management and ensure servicing goals are met or exceeded by tracking department metrics. Apply data, utilize evidence-based treatment practices and identify opportunities for improvement of quality of care and medical expense savings to design, implement and enhance utilization management and clinical care coordination processes. Track and monitor the impact of utilization management and care coordination on quality and medical expense measures
Complete monthly clinician case review audits and review semi-annual IRR results to monitor UM decision making and adherence to policies and procedures. Identify trends, develop and implement action plans for improvement progress
Provide monthly Care Management report on team(s) performance, metrics, and goal achievement to the Director of Behavioral Health
Review and develop department policies, procedures, workflows and job aids as needed, consistent with departmental and company strategic objectives and mission. Develop, maintain, update orientation materials in collaboration with clinical trainer
Work collaboratively on and manage components of quality improvement initiatives and medical expense reduction activities and ensure alignment with broader company strategy. This includes activities that support NCQA accreditation and identify and promote best practices within clinical programs
Provide information and support to internal stakeholders. Work collaboratively with other managed care entities, MassHealth, the Executive Office of Health & Human Services, as well as provider and other stakeholder groups
Other duties and projects as assigned
Qualification
Required
Experience in managing Behavioral Health teams and operations
Knowledge of Behavioral Health accreditation compliance
Ability to develop, implement, and manage initiatives and projects
Experience in hiring, training, and managing staff
Strong analytical skills to monitor and evaluate performance metrics
Ability to collaborate with internal departments and external stakeholders
Experience in quality improvement initiatives and medical expense reduction activities
Strong communication skills to provide information and support to internal stakeholders
Preferred
Experience with MassHealth and other MCOs/ACOs
Familiarity with NCQA accreditation standards
Experience in utilization management and clinical care coordination processes
Benefits
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
Company
Point32Health
Point32Health is a leading health & wellbeing organization, delivering an ever-better health care experience to everyone.
Founded in 2021
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
SMILE Health
2023-08-08Non Equity Assistance
Leadership Team
K
Kristin Lewis
EVP, Chief Public & Community Affairs Officer & Point32Health Foundation President
Recent News
2025-12-02
2025-11-07
Company data provided by crunchbase