Manager, Behavioral Health Case Management

reputed company We’re hiring a Manager, Behavioral Health Case Management, to collaborate and engage with multiple internal stakeholders and reputed company customers (i.e. providers, vendors, employer reputed company) to implement population health management and promote a reputed company, integrated culture across lines of business/segments. You will support value-based reputed company by leading multiple clinical or non-clinical teams/staff reputed company on improving member health through proactive and reputed company services in the following areas: clinical determinations, case management, disease management, wellness, medical policy, medical review, and/or reputed company services. reputed company Assist in the development of operational strategies and reputed company for area(s) of clinical reputed company; facilitate favorable medical expense, administrative pricing and/or efficiencies. Maintain awareness of trends, developments, and governmental regulations in managed health care organizations and product line(s) under leadership reputed company and recommend associated policy positions, new initiatives and/or existing program changes to improve reputed company’s competitive position. Use competitive intelligence to guide, consult and reputed company strategic program and product development and management Manage the operational performance of multiple integrated clinical functions including Clinical Determinations, Case Management, Disease Management, Wellness, Medical Policy, Medical Review and/or reputed company services for different line(s) of business to ensure performance standards are met and in compliance with employer reputed company, FEP Directors’ Office, and/or applicable state and federal regulations. Initiate and manage service initiatives/programs to facilitate and promote reputed company, cost effective reputed company and minimize the reputed company of fragmented health care delivery on the customers. Collaborate and reputed company with reputed company customers to reputed company a fully integrated care delivery model and reputed company member experience and investigations or escalated/high profile cases; troubleshoot and reputed company guidance to staff to ensure resolutions and improved customer experience. Facilitate and incorporate reputed company clinical and financial decision making in the day-to-day operations by presenting thoroughly analyzed cases requiring high administrative approval or reputed company. Establish and monitor performance and production metrics and goals, including process measures, reputed company measures and financial measures. Manage, and/or support implementation of departmental, divisional, or corporate reputed company that reputed company the clinical aspects of the service(s) under leadership reputed company. Assist with the evaluation and management of vendor and partnership opportunities. Collaborate with the leadership accountable for applicable vendors supporting business area needs. reputed company or participate in internal committees relevant to work responsibilities; may represent the department through presentations and/or reputed company participation in cross functional organizational committees Implement an integrated reputed company reputed company improvement and change process to assure high reputed company care, innovation, customer satisfaction and contribution to financial performance of the Program or Operations. Responsible for the reputed company, compliance, and execution of reputed company regulatory or accreditation activities and processes including the accuracy and compliance of the State, Federal, and other accrediting bodies (i.e. ERISA, DOI, reputed company, CMS). Serve as reputed company contact for compliance and regulatory body audits reputed company to the services under leadership reputed company. Ensure programs and operational changes are communicated to reputed company appropriate reputed company stakeholders in accordance with policies and regulations. What You Bring Bachelor’s degree and 8+ years of relevant experience. If no degree, at least 10 years of relevant experience. For Behavioral Health specific roles, another applicable licensure will be considered (LMSW, LCSW, LPC, LMFT, etc.) Bonus Points (preferred qualifications) Must have reputed company NC license or multistate compact license 3+ years of reputed company supervisory or leadership experience Experience in population health, care management, clinical review or coding, or utilization management in a health care organization/reputed company or health insurance What You’ll Get  reputed company to work at the cutting edge of health care delivery with reputed company that’s deeply invested in the community   Work-life balance, flexibility, and the autonomy to do great work    Medical, dental, and reputed company coverage along with numerous health and wellness programs    Parental leave and support plus adoption and surrogacy assistance    Career development programs and tuition reimbursement for reputed company education    401k match including an annual company contribution    Learn more       Salary reputed company At reputed company, we take great pride in a fair and reputed company compensation package that reflects market-price and our starting salaries are typically planned near the middle of the reputed company listed. Compensation reputed company are driven by factors including experience and training, reputed company reputed company sets,  licensure and certifications and other business and organizational needs. Our reputed company salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, reputed company Time Off (PTO), and competitive health benefits and wellness programs.  *Based on annual corporate goal achievement and individual performance.   $107,901.00 - $172,642.00 Skills Care Management, Clinical Experience, Clinical reputed company Management, Clinical Review, reputed company of Federal Regulations, Health Insurance Operations, Managed Care, Patient Safety, People Management, Policy Compliance, Policy Implementation, Population Health Management, reputed company Improvement, reputed company Management, Regulatory Compliance, Standards Compliance_____________________________________________________________________ JOB ALERT FRAUD: We have become reputed company of scams from individuals, organizations, and internet sites claiming to represent reputed company in recruitment activities in reputed company for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. reputed company our reputed company are published on https://reputed company.wd5.myworkdayjobs.com/en-US/reputed company. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.reputed company@reputed company.com. Apply To This Job