Manager - Behavioral Health Utilization Management

This role is responsible for leading the day to day operational performance of a care management team while ensuring high quality care management and adherence to regulatory and compliance standards for commercial and/or government program lines of business. The manager is responsible for continued enhancements of operational effectiveness while building relationships with key internal and external stakeholders.

• Manages and leads the overall care management activities and day to day operations of a successful member centric care management team ensuring program activity that achieves strategic goals and objectives.
• Builds a department environment and culture that creates and maintains high performing teams with strong employee engagement.
• Facilitates effective multi -disciplinary teamwork within the department to enhance member care and program performance.
• Design, develop, and implement innovative projects related to care management initiatives that may encompass cross functional and strategic partners.
• Acts as a clinical, care management, and business case consultant for leadership as they relate to case/disease/utilization management.
• Coordinates the development, revision and implementation of care management policies and procedures.
• Assures consistency in processes and function across teams auditing and solid business practices.
• Assure compliance with state and federal regulations, accreditation requirements, contract agreements, and performance guarantees and participates and/or leads with on-site account and provider meetings.
• Excellent communication with members, providers, management, and customers to facilitate success of member and program outcomes, department objectives, and corporate strategic pillars.
• Cultivates strong working relationships across the enterprise to promote successful execution of care management programs and key initiatives.
• Ability to analyze data, conduct root cause analysis, and recommend strategies for pilots, projects, and trends for care management initiatives.
• Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.
• Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

• Registered nurse or licensed behavioral health clinician (i.e., LICSW, LPCC, LMFT, LP) with current MN license and no restrictions or pending restrictions
• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• If a leader of Case Managers, CCM Certification or ability to obtain within 3 years of starting in the position is required.
• 3 years leadership experience leading people, projects, products, or operations
• Strong leadership ability to drive results and excel in a collaborative, matrix environment with measurable outcomes
• Excellent organizational, change management and time management skills
• Well-developed written and oral communication skills with the ability to explain complex information clearly and convincingly
• Broad knowledge of managed care and state/federal health insurance regulations
• Demonstrated skill and experience in developing highly effective clinical teams
• Strong leadership ability, proven skills in critical thinking and ability to pursue goals with tenacity and sense of urgency
• Demonstrated ability to drive projects resulting in strategic and quality outcomes

• 5 years' experience within insurance or health care setting in case/disease or utilization management
• Bachelor's or Master's degree in health care, business administration, or education preferred
• If a leader of Utilization Management, CCM Certification or ability to obtain within 3 years of starting in the position is preferred.