- Resolves problems and provides guidance to internal clinical operations and external CSA’s and state agencies
- Adapts departmental plans to address business and operational challenges
- Responsible for driving recovery and resiliency principles into the care coordination function within team and external agencies, translating these into meaningful processes and offerings for consumers
- Facilitate resolution of member issues and concerns
- Accountable for uniform and consistent application of care coordination processes / workflows within team and books of business, as well as effective implementation and management of alternate workflows where required by contract or state regulation
- Accountable for meeting or exceeding both performance and productivity metric goals as they relate to care coordination function within Care Advocacy Center.
- Responsible for informing, consulting on the production of, and using data, reporting, and analytics for successful performance and productivity of the care coordination team.
- Responsible for collaboration with peer functional leaders (e.g., Facility-Based Care, Assessment & Triage, Intake / Customer Service, Appeals, Peer Review) to ensure effective, interactive workflows and support for the goals/targets of other functional teams, as well as seamless processes for the consumer
- Ensure that Community Service Agencies’ (CSAs) Providers’ staff participate in state-required CBHI training, coaching and mentoring provided by EOHHS’s CBHI training vendor, including on-site activities, distance learning, and Quality Improvement activities recommended by the training vendor. The Contractor shall ensure that Providers’ staff completes the CBHI training, coaching and mentoring tasks assigned by the training vendor, and utilizes their new skills in service delivery. If the Provider is not participating in the training vendor’s activities, the Contractor shall engage in Provider Network Management activities to increase participation;
- Ensure that each CSA develops and coordinates a local Systems of Care Committee to support each CSA’s efforts to establish and sustain collaborative partnerships among families and community stakeholders in its geographic area.
- Participate in the local Systems of Care Committees as agreed to in collaboration with all MassHealth managed care entities and shall attend monthly meetings of the committees for the first year of the CSA implementation;
- Collaborate with case management on member assignment to CSAs
- Registered psychiatric nurse; independently licensed masters level mental health professional or licensed Ph.D. License must be unrestricted in Massachusetts
- Strong knowledge of CBHI program and processes in the state of Massachusetts
- Demonstrated leadership in the clinical and operational areas, preferably Care Coordination
- Strong analytic skills
- Reside in state of Massachusetts
- Ability to be onsite in Somerville, MA as needed
- 5 years of post-licensure diversified clinical experience in a direct services setting. Acute psychiatric, chemical dependency or outpatient therapy experience, with an emphasis in differential diagnosis
- 2 years of successful clinical and administrative management in a managed care environment
- Previous experience in a field based position
- Experience in a position where training was the main focus of your job
- Previous experience in a Program Manager role
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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: Massachusetts, Somerville, Boston, MA, Psychiatric Nurse, RN, Social Worker, Therapist, Counselor, CBHI, Children’s Behavioral Health Initiative, Program Manager, Project Manager, Manager, Chemical Dependency, Mental Health, Behavioral Health, Substance Abuse, Training, Trainer