This is a telecommuting role. The position will require occasional travel to the Detroit office and other facilities within Michigan. You will be required to attain and maintain high-speed, business class internet service for your home.
The Clinical Network Manager II manages providers to promote a high quality of care, coordinate project 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 the Health Plan, Clinical and Analytics teams to move provider networks from volume to value-based care and contract philosophy.
• Serve as a clinical liaison working between the Health Plan, NDBH Utilization Management and Care Management teams and participating providers and facilities to effectively meet the continuum of care needs for Health Plan and EAP members.
• Contribute to the design, implementation and assessment of specialized clinical and network programs in support of members with various care needs.
• Assist and promote 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.
• Assist with developing and implementing 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 the Health Plan’s Department Leadership on provider education activities including development of web-based and face-to-face presentations for orientation and education.
• Participate in professional organizations and professional development activities; maintain professional growth and development through self-directed learning activities.
• Keep current with 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 REQUIRED
• Masters-prepared clinician with current, unrestricted license issued by a state or territory of the United States to practice independently as a Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist or Registered Nurse preferably in the state where the business operation is located and/or other states as required by law, regulation or contract. For Registered Nurses, a Bachelor’s Degree in Nursing is required.
• 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; 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 skills with proficiency working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, etc.).
• Must be able to travel to provider facilities within the market with approximately 2-3 overnight stays per month.
• Must have valid driver’s license and proof of insurance.
Ability to travel approximately one week per quarter on an annual basis
• Mental Health and 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 organizational goals.
• Someone who seeks innovative ways to get things done and enlists others in realizing the vision while adeptly workingwithin 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.