The Behavioral Health Home Practice Specialist (BHHPS) is responsible for the ongoing clinical management and quality oversight of Optum’s Integrated Health Homes (IHH). The BHHPS will be responsible for developing relationships with the IHH agencies and driving a quality improvement process to improve quality, improve clinical outcomes, increase efficiency and reduce overall benefit expense. The BHHPS will monitor IHH performance and compliance with contractual obligations, provide tools to assist with performance and compliance, and is accountable for driving IHH performance improvement. As the single point of clinical contact for a practice, the BHHPS will be responsible for communicating progress towards achievement of targeted goals to Senior Leadership both within Optum and the IHH.
The BHHPS must demonstrate strong clinical and analytic skills, strong oral and written communication skills and must be comfortable working closely with senior leaders at high volume facilities/groups and/or providers. This BHHPS will work closely with Care Advocacy Operations, Affordability, Network Management teams and other relevant departments to affect desired outcomes with the Integrated Health Homes as it relates to treatment for our membership.
If you are located in or near Sioux City, Des Moines or Moline, you will have the flexibility to telecommute* as you take on some tough challenges.
- Build and effectively maintain relationship with the IHH leadership and key clinical staff
- Regularly facilitate oversight meetings with the IHH to monitor, present, and discuss performance
- Monitoring IHH performance on program metrics, quality outcomes and adherence to contract requirements
- Conduct IHH program audits and provide feedback and results
- Identify performance improvement opportunities through analysis of operational data, clinical outcome data and utilization/claims data
- Communicate with IHH agencies to initiate interventions focused on improvement of clinical outcomes and efficiency, as well as compliance with contractual obligations
- Initiate and monitor Performance Improvement Plans to drive performance
- Monitor and report effectiveness of interventions
- Modify interventions as appropriate
- Support those high performing Integrated Health Homes such that performance remains at a high level
- Provide clinical and care coordination support
- Deliver education and training
- Interface with other OHBS departments including Care Advocacy, Affordability, Clinical Network Services, Program and Network Integrity, and Quality Improvement
- Licensed Master's degree-level clinician in Psychology, Social Work, Counseling or Marriage or Family Counseling, Licensed Ph.D. level Psychologist, or Registered Nurse
- Licenses must be active and unrestricted in Iowa
- 3+ years of Managed Care and/or Utilization Review experience in a Managed Care setting is highly preferred with experience working with facility/group based care advocacy
- Experience in interpreting and utilizing clinical data analytics, outcomes measurement in healthcare and use of that data to drive change
- Demonstrated experience leading groups and strong presentation skills
- Solid computer skills at the intermediate level, proficiency with MS Office
- Willingness to travel approximately 25% for face to face meetings
- Working knowledge of Public Sector benefit plans
- 3+ years (POST- LICENSURE) direct behavioral health clinical experience
- Strong relationship building and influencing skills
- Strong written and verbal communication skills
- Ability to balance contractual and clinical considerations
- Excellent time management and prioritization skills
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: managed care, utilization review, clinical data analytics, Sioux City, Des Moines, Moline, IL, Illinois, IA, Iowa