Manager, Behavioral Health Utilization Management - New York

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.    

The Clinical Program Manager oversees a remote team of Behavioral Health Care Advocates responsible for utilization management (UM) and case management (CM) of inpatient and outpatient Behavioral Health services. UM is performed via an inbound telephonic queue and requires team members to work a holiday rotation. Case managers work directly with members both telephonically and in the field.

The schedule is Monday - Friday, 8a - 5p EST and may include working some holidays.

If you are located in New York, you will have the flexibility to work remotely* as you take on some tough challenges. Licensure and residency in New York are required.
 

Primary Responsibilities:

• Oversee utilization management for diverse populations, including adults, adolescents, children, and dual-eligible Medicare/Medicaid members with SMI, SUD, and co-occurring behavioral and physical health conditions
• Manage and be accountable for professional employees and supervisors
• Set team direction, resolve problems, and provide guidance to members of team
• Adapts departmental plans and priorities to address business and operational challenges
• Influence or provide input to forecasting and planning activities
• Oversee new product implementations
• Initiate processes for state initiatives and directives
• Update and create Quick Reference Guides
• Oversee and coordinate care with internal and external partners
• Interface with regulatory agencies
• Interview, hire, and onboard new employees
• Review reports to ensure team member adherence to established benchmarks
• Foster relationships with leadership and medical directors
• Cover for management team as needed
• May oversee work activities of other supervisors
   

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Licensed Clinician in the State of New York with one of the following licensures. Licenses must be active and unrestricted
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Mental Health Counselor (LMHC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Psychologist (LP)
• 6+ years of Behavioral Health experience including Mental Health and Substance Use Disorders
• 5+ years of utilization management experience including prior authorizations, concurrent reviews, appeal processes, and UM tools related to level of care determinations and medical necessity (i.e., LOCUS, CALOCUS, LOCADTR)
• 5+ years of experience working with the under-21 population
• 5+ years of experience working with the adult population
• 3+ years of experience managing people in a Behavioral Health setting (i.e., hospital, MCO, mental health clinic), including performance reviews
• 3+ years of experience with New York public and commercial mental health and substance abuse services delivery system
• Experience overseeing documentation in Electronic Medical Records (EMR)
• Experience with Medicare and NY Medicaid products and regulations
• Experience interfacing with regulators during audits
• Intermediate proficiency in Microsoft Office Suite, including MS Excel
• Ability to work holidays based on business needs
• Dedicated, distraction-free workspace and access to high-speed internet in home
• Residency in New York

Preferred Qualifications:

• Experience working in a Managed Care Organization (MCO)