This work from home position can be located in any city in southern Florida. and will require travel to local provider facilities.
The Clinical Network Manager manages and develops contracts with providers to promote a high quality of care, coordinate contract management, project management and administrative activities across the organization to achieve departmental objectives. Must utilize a clinical and business skillset to be a strategic business partner who actively engages with internal and external customers to achieve organizational goals.
• Work closely with Clinical and Analytics teams to move provider networks from
volume to value-based care and contract philosophy.
• Serve as a clinical liaison working between NDBH Utilization Management,
Intensive Care Management and Integrated Care Management teams and
participating providers and facilities to effectively meet the continuum of care
needs for Health Plan and EAP members.
• Create ER diversion options throughout our customers’ markets by utilizing
specialty network. Contribute to the design, implementation and assessment of
specialized clinical programs in support of members with various care needs.
• Develop high risk, high cost specialty networks addressing: chronic and
relapsing mental health conditions, substance use dependence, child and
adolescent mental health, eating disorders and autism.
• Develop and implement comprehensive provider-specific plans for qualitative
improvement in network performance.
• Utilize data analysis and identify outlier providers who would benefit from
coaching and/or training.
• Partner with our Department Directors on provider education activities including
development of web-based and face-to-face presentations for orientation and
• Participate in professional organizations and professional development activities
maintain professional growth and development through self-directed learning
• Keep current with all clinical affairs trends, policies, practices.
• Adheres to New Directions Behavioral Health Mission Statement, Core Values,
Code of Business Conduct, and Compliance Program.
• Complies with all Federal and applicable State laws and New Directions
Behavioral Health Policies regarding, privacy, confidentiality, and security of
health information, and other designated information.
• Develop diverse, responsive “best practices” networks to meet organizational
needs as measured by customer requests, geo access standards, routine
appointment availability studies and member outcomes.
• Distribution of educational material and procedures to network providers.
• Coordinate and manage delivery of educational programs such as workshops
(live and web based) and quarterly meetings.
EDUCATION & EXPERIENCE
• Masters-prepared clinician with independent licensure; substance use disorder specialty strongly preferred.
• Minimum of two (2) years post-licensure clinical experience of clinical practice.
• Demonstrated understanding and proficiency in the principles, concepts and techniques of health care management related to substance use and/or mental health.
• Knowledge of outcomes-based reimbursement strategies; behavioral health clinical protocols; contract negotiation, customer relationship management, substance use step-down levels of care within residential, inpatient and outpatient settings.
• Experience conducting financial analysis by working with claim data and Microsoft Excel spreadsheets to develop a business strategy.
• Proven track record of working as a team player to achieve business related goals that improve the quality and cost of care.
• Computer savvy with proficiency working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, etc.).
• Must be able to travel up to 50%.
• Must have valid driver’s license and proof of insurance.
• Substance abuse disorder specialty.
• Can leverage a clinical and business skillset to be a strategic business partner
who actively engages with internal and external customers to achieve
• Someone who seeks innovative ways to get things done and enlists others in
realizing the vision while adeptly working within a changing environment.
• Well-organized who can meet overall organizational needs while leveraging
resources to maximize results and positive outcomes.
• An effective communicator with excellent interpersonal skills.
• Able to function independently.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employeeswho have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access tocompensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent withthe contractor’s legal duty to furnish information.