Behavioral Health SUD Clinical Director
AmeriHealth Caritas
工作地点
Manchester, NH, USA
雇佣形态
全职工
招聘信息详细内容
Responsibilities:
The Behavioral Health SUD Clinical Director will report to the Market CMO and will work with existing providers in BH and SUD to develop better access and better outcomes for members. Impact utilization patterns for ED use as well as out of network care. The Behavioral Health SUD Clinical Director will collaborate with appropriate staff to ensure that AmeriHealth Caritas New Hampshire’s substance use disorder and behavioral health care management, utilization management and quality management programs comply with the terms of the State contract requirements and are supported by evidence-based practices.
The Behavioral Health SUD Clinical Director provides organizational leadership and clinical oversight and direction for the substance use disorder (SUD) and behavioral health (BH) components of the medical management programs. The Behavioral Health SUD Clinical Director will have responsibility for the design of programs in compliance with federal and state laws and contractual requirements. The Behavioral Health SUD Clinical Director will make recommendations regarding ACNH utilization management programs based on member and provider needs and feedback.
The following responsibilities are regarding members with diagnosed mental illness and substance abuse conditions and their providers:
• Identifying and implementing evidence-based practice guidelines throughout the provider network.
• Overseeing the quality of clinical care for network and non-network providers.
• Engaging the provider network in Continuous Quality Improvement through the diffusion of practice standards, and through an internal quality assurance program that measures network provider performance against standards of high quality, especially the performance standards embodied in the HEDIS program.
• Reviewing and resolving disputes related to the quality of care.
• Assuring a high-performing Utilization Management system that adheres to the coverage terms and requirements of the contract. The system will utilize evidence-based standards in making coverage determinations in individual patient cases that appropriately apply standards to specific cases.
• Serve as the primary external subject matter expert for ACNH for SUD and BH, including working with regulators, legislators, community organizations and providers.
• Lead the development and implementation of contractually required clinical programs, such as emergency room boarding of members with a behavioral health treatment need.
Additional Accountabilities
• Ensure the provision of quality and clinically sound SUD and BH services to all Members by associates and Providers
• Serves as clinical advisor and manager for all clinically related SUD and BH activities
• Assures that organization policies and procedures adhere to contractual obligations
• Performs clinical case reviews in conjunction with Medical Management Department
• Demonstrates knowledge of prescribed and established procedures and practices.
• Maintains familiarity with federal, state and local regulations that may pertain to the medical and clinical operations
• Participate in Complaint and Grievance processes related to service denials and clinical practices
• Participate with Quality Improvement and Medical Management in the identification and analysis of clinical information in order to develop interventions to improve effectiveness of ACNH SUD and BH programs.
• Attend case management meetings and monthly rounds as required by DHHS.
• Champion continued integration of SUD and BH with medical programs to improve integration of BH and SUD in the primary care environment.
• Adhere to AmeriHealth Family of Companies (ACFC) policies and procedures; support and carry out the ACFC Mission and Values.
• Perform other related duties and projects as assigned.
Education/Experience:
• Bachelor’s Degree
• RN, Nurse Practitioner with experience in SUD/ Behavioral Health in NH
• 1-3 years BH/SUD clinical management
