Under the direction of the Sr. Manager of Behavioral Health, this position provides clinical and administrative supervision to the Health Plan Behavioral Health utilization management, prior authorization and care management teams. This position assesses, develops, implements, monitors and documents the utilization of resources and progress of work flows and clinical processes related to utilization management and care management as needed. The position is accountable for the quality of clinical and administrative functions to ensure the health plan meets all regulatory requirements. Additionally, this position is responsible for tracking and monitoring utilization trends and assisting the Behavioral Health Director with identifying over and underutilization of services and opportunities to improve clinical programs and processes to ensure timely and quality of care services are delivered to enrolled member. This position will supervise clinically licensed staff and may assist with supervision and oversight of non-clinical staff as needed. This position will ensure positive relationships with internal and external stakeholders by communicating effectively and timely.
Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.
Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Assesses patient admissions and continued stay utilizing standard criteria. Identifies issues that may delay patient discharge and facilitates resolution of these issues.
Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.
Must possess knowledge of utilization review as normally obtained through the completion of a bachelor's or masters degree in health care.
Requires current active independent license with the Arizona Board of Behavioral Health Examiners (LCSW, LMSW, LPC, LMFT, L.Ac.) or Registered Nurse (R.N.) license in state worked.
Requires a proficiency level typically achieved with 5 years clinical experience. Must have a working knowledge of care management, acute care and/or home care environments, community resources and resource/utilization management. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format.
Additional related education and/or experience preferred.
Internal Number: 243785
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.