New Directions Behavioral Health, founded in 1995, is dedicated to helping people find a healthy balance and improve health through positive change. We offer managed behavioral healthcare, employee assistance, organizational consulting, and health coaching programs.
As behavior change experts, we provide a full range of proven practices to help individuals attain healthier and more balanced lifestyles. In fact, we serve the behavioral health needs of millions of people in Kansas, Missouri, Arkansas, and across the nation.
New Directions is the fastest growing behavioral health care company. Our services have earned national recognition and awards for innovation and best practices. And we are accredited by NCQA as an MBHO and by URAC for utilization management and case management.
New Directions Behavioral Health is seeking a Vice President, Clinical Services for our Kansas City, MO location. The Vice President, Clinical Services is responsible for the performance of the Utilization Management and Case Management functions for assigned books of business. Responsibilities include program development, quality control, implementation and maintenance of UM and CM policies and procedures and employee supervision and training
The Vice President, Clinical Services’ Key Responsibilities includes:
- Maintains positive relationships with potential, new and existing health plans purchasing clinical services from New Directions Behavioral Health
- Works closely with Business Development and Account Management in implementing new business; specifically educating staff on changes, and tracking and education of staff of benefit plans for health plans
- Works closely with New Directions customers; has accountability for building positive customer relationships through day to day collaboration as well as through regular joint meetings.
- Manages ongoing relationships with health plan customers on UM and CM concerns, promoting prompt and effective problem resolution
- Develops strategies for successful HEDIS outcomes for all customers.
- Develop education programs for UM staff related to UM and CM policies and procedures, information systems, medical necessity criteria, peer review activity, care planning, engagement, cultural diversity and others. Works as a team-member with clinical management peers.
- Assures UM and CM policies and procedures are in compliance with URAC, NCQA and new laws. Educates staff on any changes. Updates policies as needed.
- Mentors and trains staff in administration of processes required by URAC/NCQA.
- Works closely with information services to develop software and system changes to UM function.
- Assists in the oversight of appeals and denials.
- Coordinates with Director of National Clinical Services to promote smooth and effective transactions between Customer Service, UM and CM departments to promote consumer and Provider satisfaction.
- Provides supervision to the UM and CM staff during the workday as assigned.
- Works with Network Development staff to assist in communicating UM and CM policies and procedures to facilities and providers.
- Work with trainers to orient new employees to New Directions and assists with developing programs for entire New Directions staff.
- Identifies customer service issues and works with specific areas as needed to resolve issues.
- Works closely with Chief Operating Officer related to claims process and improvement.
- 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. Complies and New Directions Behavioral Health contractual/account requirements.
- Maintains licenses, CEUs, and certifications and required by applicable state laws and New Directions Behavioral Health.
- Adheres to the New Directions Behavioral Health policies.
- Assumes other duties consistent with position and as directed by the Regional Vice President, Chief Medical Officer or President
- Licensed mental health professional with a minimum of a Master’s Degree, Licensure in MO or KS preferred.
- 10 years of experience in a managed care setting including behavioral health utilization management and case management with at least 5 years post graduate clinical experience.
- Minimum of 3 years of experience in a supervisory role.
- Understanding and experience in Quality Management.
If you’re ready to join a team of professionals that are dedicated to making a difference, we want to hear from you!
New Directions Behavioral Health is an Equal Opportunity Employer M/D/V/F.
We offer a very competitive compensation and benefits package.
For consideration, please apply on-line at www.ndbh.com.
New Directions Behavioral Health - 10 months ago