Provide overall contract management and contract oversight for Illinois based client.
The Program Director is required to be educated in current principles, procedures and knowledge domains of case management as well as utilization review based on nationally recognized standards of care management and must be a licensed behavioral health clinician. Utilization review Re-verification to occur at a minimum of every 3 years.
1. Oversee all operations of the office.
2. Ensure contractual and delegation agreement compliance.
3. Responsible for all contractual reporting requirements as outlined in the contract and delegation agreements.
4. Reporting and analysis of program utilization and related performance indicators.
5. Attendance at contract meetings, as well as other external meetings with stakeholders.
6. Direct operations supervision of clinical staff.
7. Provides operational support to all staff.
8. Attends/telephones in for internal Beacon operation meetings.
9. Works closely with Director of Clinical Management and Director of Quality Management and Improvement on all NCQA/URAC initiatives, including lead for some initiatives/standards.
10. Leads CQI teams as assigned/needed.
11. Assists in Network Management activities as needed.
12. Other duties as assigned.
· Master’s degree or higher in a health related field and licensure as a behavioral health professional.
· BSN, licensure as a professional and 3 years behavioral health clinical practice
· Licensed behavioral health clinician/nurse who has Certification as a Case Manager is preferred.
COMPREHENSIVE CARE SINCE 1996
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