New Directions Consulting, Inc.
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Sr. Manager, Clinical Network Operations - Birmingham, AL
at New Directions Consulting, Inc.
Responsible for leadership and mentoring of the clinical network managers serving customers across multiple markets. Lead the clinical network managers in developing collaborative relationships with facilities and health care systems to develop innovative solutions and deliver quality outcomes. Responsible for building partnerships with business, account management, clinical, quality, legal, product innovation, and other departments to develop and maintain high performance behavioral health, substance use disorder, and specialty networks to provide the clinical delivery systems to support member and customer needs.
- Development and maintenance of standardized processes, desk top procedures, policies, project plans, tools, templates, and training and onboarding materials for clinical network managers
- Communicate roles and responsibilities and set expectations for clinical network managers
- Work with clinical network managers to develop relationships with facilities that align with New Directions clinical philosophy, support evidence based practices, lead to the development of innovative programs and services and transform the network from fee for service to value based performance arrangements
- Partner with business and account management to develop and maintain customer relationships, participate in meetings with customers, and serve as the lead network point of contact
- Review and discuss quality indicators and outcomes with contracting staff and network management which may be associated with value based arrangements
- Identify gaps and create targeted clinical/network strategies to develop and/or expand programs and services to meet member needs
- Serve as the primary network representative to review clinical, quality, and network scorecards and dashboard metrics and collaborate to streamline processes to effectively communicate, address, and resolve root causes of poor provider performance
- Investigate and resolve complaints as forwarded by the quality department and/or at customer request
- Monitor development of annual site visit plan and schedule
- Facilitate and/or participate in Membership Committees to review provider requests to join the network – determine needs for inclusion based on established criteria
- Contribute to the design, implementation, and assessment of specialized clinical programs in support of members with various care needs. Develop high risk, high cost specialty networks addressing: chronic and relapsing mental health conditions, substance use dependence, child and adolescent mental health, eating disorders, and autism.
- Collaborate on development of provider networks and systems which address integration with physical health providers and offer alternatives to traditional and/or higher levels of care
- Develop and implement comprehensive provider-specific plans for qualitative improvement in network performance
- Utilize data to identify and target outlier providers who would benefit from coaching and/or training
- Organize and lead projects to improve HEDIS and cost of care initiatives
- Partner with other departments on provider education activities including development of web-based and face-to-face presentations for orientations and education
- Participate in professional organizations and professional development activities; maintain professional growth and development through self-directed learning activities
- Keep current with clinical trends, policies, practices, and workflows; ensure that staff adhere with all required activities including security, privacy, and clinical protocols as appropriate
- Lead, coach and mentor team
- Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct, and Compliance Program.
- Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information.
This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities as deemed necessary.
EDUCATION & EXPERIENCE REQUIRED
- Masters-prepared clinician with independent licensure; mental health and substance use disorder specialty strongly preferred.
- Minimum of five (5) years post-licensure clinical experience of clinical practice.
- Demonstrated understanding of and proficiency in the principles, concepts, and techniques of health care management and case management principles
- Proven track record of working as a team player to achieve business related goals that improve the quality and cost of care.
- Computer savvy with proficiency working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, etc.).
- Must be able to travel to provider facilities.
- Must have valid driver’s license and proof of insurance.
- Health Plan experience preferred.
- Medicare and Medicaid experience strongly preferred.
- Effective communication skills – written and verbal.
- Works well within team environment – within department and other departments within New Directions.
- Work well independently