Under direction of the Senior Director Health Plan Systems Operations and in collaboration with the Chiefs of Psychiatry and HP Medical Center Behavioral Health Managers, oversees and coordinates Behavioral Health departmental quality and compliance efforts, and provides oversight to the Behavioral Health Referral functions of Behavioral Health Utilization Management (UM) department.
+ Serves as the Co-Chair of Behavioral Health Quality Improvement Committee and is accountable for development of the Behavioral Health Quality Improvement Work plan.
+ Ensures compliance with all related regulatory and accreditation requirements.
+ Oversees Behavioral Health UM and referral process to ensure compliance with regulatory standards.
+ Manages Behavioral Health UM health plan staff to ensure daily UM activities are applied in a consistent, effective manner and in accordance with department goals and targets at all levels of patient care.
+ Works in partnership with Behavioral Health Service Chiefs, UM Physicians, and Behavioral Health Managers to: make decisions on complex discharge cases to ensure high quality, patient centered transition of care, and cost effectiveness; and coordinate Inpatient Concurrent Reviews (Authorization of Additional Days and Adverse Decisions) and Transitions at Time of Discharge.
+ Provides subject matter expertise and oversight for behavioral health related referral decisions.
+ Serves as liaison to the Behavioral Health Department and Regional Quality Improvement Committee.
+ Provides support to Regional Network Management committees.
+ Performs other related duties as assigned.
This position will be located in New Carrollton Medical Center. Must be willing to travel to Regional, facilities where BH team is located. On call is needed to support weekend staff. May have to work a weekend as needed.
+ Minimum five (5) years of post master's clinical experience in the Behavioral Health required.
+ Minimum three (3) years of supervisor experience in Behavioral Health required.
+ Minimum one (1) year of Utilization Management experience required.
+ Master's degree in social work, psychiatric nursing, or a PHD in clinical psychology required.
License, Certification, Registration
+ LCSW, LICSW, CNS, or Licensed Clinical Psychologist required.
+ If MSW, Certified Social Worker required.
+ National Provider Identification (NPI) required.
+ Comprehensive understanding of behavioral health and chemical dependency issues and regulations required.
+ Proficiency with word processing, database, spreadsheet, and presentation applications required.
+ Effective interpersonal and conflict resolution skills required.
+ Ability to analyze problems and problem-solve using a team approach required.
+ A cooperative and professional attitude with internal and external customers required.
+ Behavioral Health Utilization Management experience preferred.
+ Affiliation with National Association of Social Workers preferred.
+ Knowledge of outcomes' measurements, design, and research tools preferred.
+ Familiarity with HEDIS and NCQA Behavioral Health standards preferred.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
TITLE: Behavioral Health Manager - Utilization Management
LOCATION: Rockville, Maryland
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.