The Supervisor – Utilization Management Behavioral Health, provides direct oversight of all aspects of Utilization Management as it relates to the management of behavioral health authorizations, workflows, and processes as well as all aspects of quality improvement activities. This position provides training and coaching for groups individuals, noting achievements and progress when completing individual performance evaluations as well as addressing and/or taking disciplinary actions if necessary. This position requires sound knowledge of clinical practice and exceptional leadership abilities. The UM Supervisor – BH may represent the unit in cross agency collaborative needs.
This position is full-time remote. The selected candidate must reside in North Carolina.
Responsibilities & Duties
Implement Unit Goals and Objectives
Ensure consistent application of medical necessity criteria for physical health services that promotes a holistic review of the member’s needs
Ensure the Utilization Management Department serves as an integrated department through effectively collaborating with Physical Health counterparts
Supervise and Develop Staff
Work with Human Resources and Unit Director to maintain and retain a highly qualified and well-trained workforce
Ensure staff are well trained in and comply with all organization and department policies, procedures, business processes and workflows
Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
Ensure all staff are treated with respect and dignity
Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
Work to resolve conflicts and disputes, ensuring that all participants are given a voice
Set goals for performance and deadlines in line with organization goals and vision
Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
Cultivate and encourage efforts to expand cross-team collaboration and partnership
Daily operational oversight of the UM Department
Ensure consistent application of medical necessity criteria for behavioral health services that promotes a holistic review of the member’s needs
Reviewing Physical Health Services
Ensure compliance with performance measures outlined within NC DHB, NC DMH contracts and all accrediting body standards
Monitor systems that ensure the authorization of services provided by clinical care staff appropriately address the service needs, types of service, outcomes, and alternatives available to consumers
Provide education to hospitals and other care providers concerning departmental procedures and requirements for approving length of stay extensions
Perform other related duties as required by the immediate supervisor or other designated Alliance Health administrators
Analyze and monitor community capacity for service needs, service gaps, and the implementation of evidence based/best practices
Review and Revise department Desk Manual as needed
Complete mediations for denial or reduction of Behavioral Health Medicaid and Non-Medicaid services completed by Alliance Health
Represent Utilization Management determinations for Behavioral Health services in court as requested by legal counsel
Assess and improve the department’s performance based on established indicators and outcomes
Attend federal, state and local meetings as agency liaison
Ensure authorized services address appropriate service needs, intensity of service outcomes, and alternatives for consumers
Support Sr. UM Director and UM Directors in reporting data and quality metrics
Education & Experience
Requires a Master’s Degree in psychology, social work, counseling or related field and, current and active professional licensure as a LCSW, LCMHC, LPA, LMFT, LCAS, or Licensed Psychologist with a minimum of five (5) years post Master’s experience, one of which was in a supervisory, administrative, lead or management position.
Experience is Utilization Management is preferred.
Knowledge, Skills, & Abilities
Must be knowledgeable in Utilization Management managed care principles and strategies
Working knowledge of State guidelines and policy related to utilization management and review
Considerable knowledge of populations being served
Knowledge of Federal and State regulatory agency standards related to behavioral healthcare and healthcare organizations
The ability to retrieve, communicate and present data and information both verbally and in writing required; has the ability to express or exchange ideas verbally and in writing
Must employ a professional style that promotes interagency cooperation and have the ability to promote efficient use of program resources to attain desired outcomes
Possess excellent problem-solving skills
Must be creative, highly motivated and able to operate successfully within a team management model
Knowledge of diagnostic treatment guidelines/protocols, level of care criteria
Ability to develop and document workflows
Written and oral communication skills
Ability to analyze effectiveness of processes and make adjustments to developed processes.
Demonstrates ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations.
Ability to lead, delegate and problem solve
Proficient in the use of computer and multiple software programs
Experience with health plan accreditation (NCQA/URAC)
Exact compensation will be determined based on the candidate’s education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave