UM Physical Health Asst. Director (Hybrid/Remote)

Competitive Compensation & Benefits Package!

Position eligible for -

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details.

Office Location: Hybrid/Remote Option Available; Flexible for any of Partners' locations.

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of Position: The Physical Health [PH], Utilization Management, Assistant Director of Operations, reports directly to the Senior Director of PH Utilization Management and Transitional Care. The expectations include, but are not limited to, implementing systems and operational and ensuring the progress of strategic plan goals, department initiatives, and organizational priorities. This position works closely to foster efficiency and quality within the PH Utilization Management and Transitional Care department. This position provides collaborative management of the physical health team and requires a dynamic, proactive approach to manage, evaluate, and monitoring to ensure quality supports and consistent adherence to NC DHHS requirements. This is a mobile position requiring work in various locations.

Role and Responsibilities:

Clinical/Operational Leadership

• Oversees the daily workings of the physical health utilization management and transitional care team to direct the associated tasks but to also work collaborative with external delegated providers.
• In addition, this position consistently collaborates with the BH Utilization Management and Benefits Team to ensure that Partners is offering cost efficient and clinically effective services, members are receiving the benefits as intended, and maximizing the clinical efficacy of the services offered.
• Implements systems and operational guidelines in accordance with the guidance of the Senior PH Utilization Management and Transitional Care, Director.
• Under the guidance of the organizations Senior Leaders and directly with PH Senior Director, engage efforts associated with direct oversight of the activities related to the Tailored Care Management contract and moving in the direction of becoming an optimally managed, Health Plan.
• Ensures the progress of strategic plan goals, department initiatives, and organizational priorities.
• Represents the PH Utilization Management and Transitional Care, department in committees, stakeholder meetings, and other workgroups as requested.
• Collaborates with leadership across departments to foster efficient communication flow and solution focused problem solving.
• Provides leadership to promote strong cohesiveness among all company employees regardless of department, role or office location...promotes one vision, one voice.
• Ensures all activities are implemented according to the guidelines and regulations of the Tailored Plan Contract, Medicaid Direct Contract, Mercer, NCQA, and External Quality Review and established protocols/procedures.
• Monitors service implementation through monthly monitoring activities, supervision, and monthly review of key performance data.
• Oversees implementation of an active performance improvement/quality assurance process, including Quality Improvement Projects, Strategic Plan, and Local Business Plan.
• Models and promotes person centered practices, including use of person-centered language and person-centered tools in both management and clinical planning.
• Monitors effectiveness of systems and guidelines through review of data and addresses identified issues/concerns.
• Completes all required reporting requirements, including reporting on performance indicators.
• Participates in internal/external reviews and ensures follow-up is completed as needed.
• Promotes a spirit of active collaboration with others both internally and externally, with focus on and positive outcomes for individuals supported.
• Evaluates utilization data, trends, member/recipient demographics related to services.
• Oversees Performance Indicator reports and use the information in team-based processes for designing quality improvement strategies and annual utilization benchmarks.
• Provides input, management and initial creation of PH Utilization Management Policies and Procedures, Manages the inter-rater reliability process for UM/UR staff to ensure standardized and consistent application of current UM processes.
• Provide supervision and guidance to the Appeals Team, utilizing state and federal regulations for Due Process
• Ensures regular observations, reviews of job performance and ongoing supervision to ensure appropriate provision of all activities.
• Reviews and approves all employment paperwork for employees (e.g. timecards, employee reimbursement requests, etc.)
• Ensures appropriate documentation of meetings and clinical supervision.
• Ensures all HR and related procedures are followed.
• Ensures that all employees within team receive ongoing training of changes in state, agency or departmental regulations, policies, procedures, service definitions, and operations guidelines.
• Ensure compliance with delegated entities that are parallel to the work of the department.

Knowledge, Skills and Abilities:

• Excellent organizational and management skills
• Ability to coordinate, effectively train/coach and oversee the duties of others to ensure high quality services.
• Working knowledge and expertise in the areas of mental illness, housing first, case management, and psychiatric rehabilitation
• Working knowledge of laws, regulations, and program practices/requirements impacting members/recipients
• Ability to exercise judgment and discretion in applying and interpreting policies and procedures.
• Ability to exemplify and promote in others a positive, solution-focused attitude.
• Ability to promote effective partnerships between Partners staff, providers, and community stakeholders.
• Ability to understand and carry out complex oral and written instructions.
• Ability to establish and maintain positive and effective working relationships with associates, officials and the public.
• Ability to work effectively with others to promote a team effort to address the needs of the individuals served.
• Ability to express directions, comments and opinions clearly and concisely in oral and/or written form.
• Excellent ability to understand and interpret complicated written material and verbal presentations.
• Diplomacy as well as the ability to handle stressful situations is essential.
• Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
• Excellent problem solving, negotiation and conflict resolution skills.
• Propensity to make prompt, independent decisions based upon relevant facts and established processes.
• Detail oriented, able to independently organize multiple tasks and priorities, and to effectively complete reporting measures within assigned timeframes.

Education/Experience Required:NC Registered Nurse, with a BSN and/ormaster's degree with at least three (3) years of utilization management and care management experience with a minimum of three (3) years of administrative supervisory experience.

Other requirements:

• Must reside in North Carolina.
• Must have ability to travel to travel to perform the job duties.

Education/Experience Preferred: Previous professional experience with Medicaid Managed Care Utilization Management

Licensure/Certification Required: Fully Licensed Registered Nurse [RN] in the state of North Carolina. Employee is responsible for complying with respective licensure board's continuing education/training requirements in order to maintain an active license.