Manager, Clinical Program -Behavioral Health Utilization Management

Location: This position is located at our Dublin, OH campus.

Who we are

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Manager, Clinical Program – Behavioral Health Utilization Management (BH UM) is responsible for supporting the Director, Clinical Program – Behavioral Health in providing clinical leadership to the BH UM team. This individual works in partnership with the Director and the clinical team to ensure consistency of clinical activities within Quantum Health’s BH UM program and to support the mission and core values of the organization.

What you’ll do

Recruiting and retention, including supporting new hire selection

Direct management of behavioral health clinicians and support staff

Deliver performance feedback. Responsible for performance management / coaching support to clinical staff to develop team and maximize success of employees

Support and model community-like culture within the team to recognize and reward innovation that improves our member and employee satisfaction

Oversee the assimilation of new clinical and support team members and ensures continuous development via skill building and refresher training programs as well as quality monitoring process

Conduct 1 on 1 meetings and quarterly check in/review conversations with all assigned clinicians leveraging data provided by cross-functional teams

Lead the succession planning and IDP process for employees to ensure continued professional development and delivers the feedback for high potential employees

Facilitate clinical huddles to ensure collaboration with workload and case needs

Lead content creation and facilitation of team meetings in partnership with their leadership

Support maintaining a culture of camaraderie, partnership and collaboration

Ensure accountability and shared responsibility for providing high-quality member and provider support

Maintain effective relationships with our clients and communicates information with respect to client expectations

Responsible for partnership with external plan partners including Third Party Administrators (TPA), Pharmacy Benefits Managers (PBM), and Vendor Partners to ensure support for the client's plan and members on immediate issues or concerns

Identify and resolve problems to ensure client and member service is maintained at the highest level and communicate any trends to Pod leadership for escalation

Partner with leadership to ensure effective client implementation and keeping the Client Executive aware of issues/trends

Participate as a Clinical Leader in prospective/current client site visits

Provide clinical support to Pod leadership and CEG teams for escalated client cases

Serve as the key clinical leader in advocacy and clinical audits through presentation of material, answering questions, recapping themes needing addressed in partnership with the Director of Clinical Quality and Accreditation, Clinical Trainers, Clinical Program Leadership, Clinical Delivery Leadership, and Pod Leadership

Serves as an Expert Resource

Reinforces expectations regarding process, protocol, program design

Accessible to staff to answer questions and clarify expectations, as needed

Assist with resolving escalations and complex challenges

Communicates information with respect to client expectations, business results/metrics, member satisfaction and team culture

Provide clinical specialty team support including: triage PSR (Patient Service Representative) questions and provide clinical guidance as indicated, triage clinical questions and resolve/delegate appropriately, be available as clinical resource/support for leadership and specialty team staff

Monitor and adjust daily clinical workload within the team

Maintain a working knowledge of all clinical workflows and policies

Responsible for helping team members get answers to questions, resolution to issues, and support for action to help improve the member’s healthcare journey

Other duties as assigned

What you’ll bring

Licenses: Active license as a Registered Nurse in the State of Ohio

Minimum 2 years of Behavioral Health experience

3 - 5 years of experience preferred managing a Behavioral Health team

Experience mentoring and/or coaching in a clinical setting

Excellent verbal and written communication skills

Proven ability to deliver results in a high-service healthcare or insurance environment (preferably a fast-paced, service based, efficiency driven background)

Diverse knowledge base of role and function of all nursing functions within the department

Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.

A high degree of personal accountability and trustworthiness, a commitment to working within Quantum Health’s policies, values and ethics, and to protecting the sensitive data entrusted to us.

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