Clinical Manager, Behavioral Health Care Management

Summary of Job

Responsible for the day-to-day operation and performance of the behavioral health care management team providing care management services to EmblemHealth (EH) members. Monitor performance and productivity of the team. Develop and implement workflows to ensure members receive timely, high quality care management services. Develop and provide team trainings as needed. Provide coaching and mentoring to team members to address performance related issues. Use problem solving abilities to create solutions to operational and clinical issues identified during day to day operations. Collaborate with the Director and AVP of Behavioral Health Care Management and internal audit teams to address audit related findings and implement performance improvement strategies. Collaborate with other functional areas within the organization to ensure that care managers are implementing EH Health Plans policies, procedures and all regulatory mandates, consistent with our mission, vision, purpose and value statement.

Responsibilities:

• Provide input into the hiring and selection process; serve as a preceptor to newly hired staff.
• Train and develop staff to ensure all aspects of required performance are communicated and understood; provide clear performance metrics to ensure actions are linked to departmental goals.
• Give ongoing feedback to ensure there is a continuous understanding of how the employees are performing; provide coaching, support, and open (two way) lines of communication to eliminate gaps in understanding.
• Mentor staff to maximize opportunities for performance excellence and advancement.
• Complete evaluations of staff as needed; acknowledge positive accomplishments and identify areas for improvement.
• Provide concrete action plans to develop areas for improvement; implement and follow through on plans.
• Manage daily operations of the Care Management team including measurement of performance metrics and productivity standards and deploy strategies that will improve performance.
• Monitor team caseloads and shift workloads accordingly to meet departmental/organizational needs.
• Monitor timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards. 
• Ensure team members are managing enrollees across the care continuum, including collaboration with medical Care Management, Behavioral Health vendor, and community resources.
• Serve as a clinical resource and attend Care Management rounds.
• Perform independent research to maintain industry level knowledge of the behavioral health environment, including current and forthcoming changes to processes, practices, and federal/state/local regulations.