Manager Clinical Health Services – Ohiorise

Manager Clinical Health Services – Ohiorise

Requirements

• Ohio resident
• Active unrestricted Independent Ohio State Licensure in applicable functional area. (e.g., RN, LPPC, LPPC-S, LISW, LISW-S, LMFT)
• 5 years’ experience in clinical area of expertise
• 3 years’ leadership experience including the oversight of staff, preferably in a managed care organization
• Willing and able to participate in up to 10% of travel for any as needed health plan meetings
• Computer literacy and experience with Microsoft Excel, Word, and other web-based applications.
• Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.
• Ability to communicate effectively and professionally with Providers, Members, Staff, External entities, and Leaderships both in oral and written formats.

Responsibilities

• Administers an effective Clinical Health Services program through multi-disciplinary teams to improve health care outcomes and client satisfaction.
• Develops actionable insights on opportunities and fosters programs to improve the operational efficiency and cost-effectiveness of Clinical Health Services processes and programs.
• Oversees the Clinical Health Services department’s compliance with federal and local requirements and departmental guidelines and procedures.
• Plans, develops, and manages the budget, exercising appropriate fiscal constraints to ensure the most efficient and economic practices for optimal service delivery within established budget.
• Remains abreast on all current laws pertaining to the department and company operations.
• Negotiates written agreements with outside providers and facilities in conjunction with other internal departments.
• Establishes and maintains cooperative and productive professional relationships with health coordinators and case managers at various facilities and community organizations.
• Provides direct supervision to the Clinical Health Services staff, and other staff personnel assigned to the administration.
• Ensures professional cooperation between Clinical Health Services and all other departments and administrations.
• Serves as a model to team member regarding practice standards, quality of interventions, problem resolution and critical thinking.
• Evaluates and interpret data, identify areas of improvement, and focus on interventions to improve outcomes to including best practice standards and innovations to better address member needs across the health plan.
• Assist in the support, development and oversight of all communicate and documentation standards required for Care Coordination Phone Queue Line, Care Coordination Email and any large scale needs identified by the Health Plan.
• Works independently and can takes initiative on identifying interim/permanent solutions to daily or large-scale problems.
• Supports and establish a positive work environment that promotes teamwork, acknowledges team contributions, solicits input, and offers personal assistance when needed.
• Maintains flexibility and adjust to changing needs within health plan needs that may require ongoing Re-prioritization of tasks.
• May develop/assist in creation and/or review new training content for immediate team and/or collaborate/deliver inter-departmental training sessions as needed.

Preferred Qualifications

• Managed Medicare/Medicaid experience
• Case Management experience