Director, Clinical Operations Children's Services

Description and Requirements

The Behavioral Health (BH) Children's Services Director is a key member of the BH leadership team who oversees BH Care Management staff for all pediatric lines of business and behavioral health services. The Director monitors the clinical functioning of the Children's Services program model and provides oversight of the Children's utilization management teams and case management teams' activities. The incumbent supervises, analyzes, and coordinates Behavioral Health daily activities to ensure that departmental productivity goals are met regarding quality care, compliance, and clinical coordination. This includes management of the Children's teams, as well as developing efficient and effective service delivery systems that will ensure a high level of quality care and compliance. This position creates and implements programs that target and support integrated care for our members under the age of 21.

Duties/Responsibilities:

• Provides leadership and directs the home and community-based services (HCBS) and case management program of the Children's Services unit for Healthfirst members ages 0-21.
• Participates in all aspects of the team's management and employee lifecycle to ensure appropriate talent management.
• Ensures a team atmosphere that fosters open communication, collaboration, ownership, and empowerment to make decisions
• Ensures guidelines as mandated by CMS and NY State regulations, job aides, and HF policies are followed. This includes review of individual and aggregated CM performance audit results in order to maintain superior and accurate care data for each HF member
• Participates actively in strategic planning for BH department clinical operations including special projects and pilots
• Represents Healthfirst at city and state meetings, external presentations, and provider forums to educate and build collaborative relationships
• Oversees children's behavioral health initiatives and direction that support safe, aggressive treatment resulting in quality outcomes and cost-effective care
• Addresses issues identified by internal risk assurance functions including but not limited to fair hearing process, SIU, etc.
• Demonstrates proficiency in reviewing and analyzing utilization and productivity data and flexibility in managing to report results
• Uses data to optimize BH Care Management department integration and operations including workflows; policies and procedures; utilization management practices; and quality monitoring
• Identifies key improvements that will advance operations and further the seamless integration of the behavioral health and general medical teams
• Performs other duties as assigned

• Bachelor's degree from an accredited institution
• Current License/Certification as Behavioral Health Professional, such as Psychologist, Social Worker or Licensed Mental Health Counselor (i.e., LCSW, LMHC, LMSW, PhD, PsyD.)
• Seven years of experience in a BH managed care setting or BH clinical setting, including at least two years of managed care experience (preferably Medicaid managed care) and at least five years of experience working with children
• Demonstrated effectiveness with written and oral communication
• Demonstrated effectiveness of interpersonal skills and the ability to work effectively at all levels in a collaborative team environment

• Master's degree from an accredited institution
• Knowledge of the various child serving systems in NYS
• Knowledge of NYS Medicaid Program
• Experience in strategic development and operational management in a managed care organization with a focus in Behavioral Health
• Prior work experience in education
• Experience with clinical operations, clinical quality, quality assurance and/or project management
• Experience working with high performing, cross functional teams
• Sound organizational skills with the ability to handle multiple tasks and prioritize appropriately
• Flexible, adaptable, and excellent problem-solving skills with a proven track record for driving results