Job Description :
This job leads a team of licensed clinical behavioral health professionals who deliver case management, condition management, and health coaching services to the Organization's members. Accountable for daily operation of unit including staffing and scheduling to ensure that member outreach is effective and completed within defined timeframes and according to established processes. Ensures that team members are clinically competent and adequately trained in order to achieve member engagement targets as well as defined clinical and financial outcomes and establishes and monitors individual and team performance goals providing feedback and taking action to ensure that goals are achieved. May lead/participate in work groups focused on continually improving the efficiency and effectiveness of the case management, condition management, and health coaching services delivered to members.
We are hiring for 2 territories. One is the suburbs surrounding Pittsburgh and the other is Hershey and Harrisburg.
- Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
- Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
- Leads a team of licensed clinical behavioral health professionals responsible for delivering case, condition, and health coaching services to specific segments of Highmark’s membership. Segments may include commercial, Medicare Advantage, or ACA populations.
- Ensures that health coaching and case management services are proactive, innovative and engaging from the member and group customer perspective. Establishes individual and team performance goals in collaboration with leadership and then monitors both individual staff and team performance quantitatively and qualitatively to identify and act upon opportunities to improve overall performance, outcomes, and exceed goals.
- Ensures that team members are clinically competent and adequately trained in motivational interviewing and other engagement techniques in order to achieve the team’s engagement and clinical targets in addition to any client-specific operational, clinical or financial commitments/performance guarantees.
- Leads/participates in both departmental and interdepartmental workgroups to continually enhance the delivery of programs and services and proactively respond to changing client and market expectations.
- Participates as requested with Clinical Client Relations (CCR) and Sales in addressing individual client concerns and/or requests for clinical reviews/audits.
- Participates in both internal and external assessments of performance, such as NCQA, by preparing for, participating in and responding to audit findings and recommendations.
- Other duties as assigned or requested.
- Bachelor's Degree - Behavioral Health, Psychology or other clinical related field
- Prior behavioral health related work experience
- 7 years' of behavioral health related work experience
- 3 years' management or supervisory experience including working on project teams
- Certification in case management (CCM)
- Experience in a comparable management role in a health-related setting
- Excellent interpersonal and communication skills relative to the ability to mentor and develop talent amongst team members. Strong ability to collaborate with peers and other stakeholders within the enterprise
- Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data
- Computer literacy with moderate proficiency in Microsoft Office products
LICENSES AND CERTIFICATIONS
- Registered Nurse, Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage OR Family Therapist (LMFT)
LANGUAGE REQUIREMENT (other than English)?
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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