Clinical Director - Behavioral Health - Rancho Cucamonga - Job #881

Job Description

POSITION PURPOSE

Under the direction of the Executive Director of Population Health, the Clinical Director of Behavioral Health is responsible for clinical oversight and management of the IEHP Behavioral Health activities, including case management, participation in the quality management, and oversight of the grievance and credentialing functions for the Behavioral Health Program.

The Clinical Director oversees the inpatient/concurrent review process and all levels of behavioral health care provided to IEHP members. The Clinical Director of Behavioral Health coordinates care with the County Mental Health Plans who are responsible for substance use disorders treatment as well as care for individuals with serious mental illness and substance use/addictive disorders.

The Clinical Director also provides leadership for all community and provider partners who are foundational to the effectiveness of the IEHP Behavioral Health Department.

MAJOR RESPONSIBILITIES

Participate and at times lead cross-organizational initiatives and program from the 5 strategic Priorities, driving IEHP to become a 5-star health plan.Work closely with the Executive Director of Population Health and other leaders to move IEHP toward the goal of supporting whole person care for their members and the larger community, including developing structures and processes inside IEHP that support whole person care.

Provide leadership, modeling, messaging and advocacy inside and outside IEHP for the importance of behavioral health (broadly, including mental health, SUD, health behaviors) in whole health.

Oversee and manage BH department’s human capital effectively, respectively and efficiently, by ensuring all employees are working at the top of their scope, and their expertise and strengths are matched to their positions.Provide leadership in employee engagement and member experience activities and initiatives, ensuring both are integrated deeply into work processes and protocols.Ensures the clinical integrity of IEHP’s utilization management (UM) functions.Ensure the BH Department’s call center and other member-facing services are clinically sound, effective, person centered and efficient.

Ensures that members are provided sufficient Behavioral Health services coordinated with necessary medical attention throughout IEHP’s geographic coverage area.Works with the Contracting Department and other IEHP departments to grow and ensure a qualified, robust network of behavioral health services for members; maintains and increases the collaboration and partnership with all network providers.

Participates in the UM program for IEHP and its Behavioral Health providers which includes protocol, procedures, oversight, and training in the following areas:

• Provider selection

• Credentialing

• Quality Assessment Studies

• Peer Review Activities

• Referral Management

• Pre-admission authorization

• Prospective, concurrent and retrospective review

• Utilization review reporting and evaluation

• Case Management

• NCQA Accreditation

Reviews State mandated benefits to ensure IEHP Behavioral Health is in full compliance. Any other duties as required to ensure the Plan’s Mission and Values are delivered in the community. Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

Pay Range: $146,400 - $226,900

Qualifications

MINIMUM QUALIFICATIONS

Education/License:

Master’s Degree required, in Social Work or Marriage and Family Therapy; Doctoral Degree Preferred. Licensure through the California Board of Behavioral Sciences is mandatory. Possession of a valid State of California driver’s license.

Experience:

Five or more years of management experience in a health care delivery setting; experience in integrated behavioral health/medical settings is preferred. Experience in an HMO or managed care setting helpful, including Medicare Advantage health plan or Managed Behavioral Health Organization.

Knowledge/Skills Required:

Deep understanding of the importance of employee and member (patient/client) experience in the delivery of care, and knowledge and experience of successfully developing and implementing interventions for both. Knowledge and experience in working with the underserved and/or those publicly insured. Able to thrive in a fast paced, dynamic workplace, and tolerate ambiguity without negative stress reactions.

Able to successfully develop and maintain genuine relationships with colleagues, including supervisors, direct reports and those outside of the department. Thorough understanding of the developing partnerships inside and outside of the organization, and a demonstrated history of doing so, in order to successfully execute initiatives and projects.

Must have excellent verbal and written communication skills, including the ability to communicate clearly and kindly when under stress. Sensitivity to a multi-cultural and multi-socioeconomic environment and community. Ability to take initiative, think boldly, and persistently work toward changes.

Successful Project management and team building experience essential. Word processing involving computer keyboard and screens, automobile travel within the Inland Empire.

Microcomputer applications such as Microsoft Word, Excel, and Access helpful.

Special Instructions

Job #881