Senior Manager of Care Management, Behavioral Health Director of BH Programs and Strategy

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Senior Manager of Care Management, Behavioral Health (BH) is responsible for the overall coordination and management of in-house health plan BH care management processes, operations and functions. The Senior Manager collaborates in the development and implementation of strategies to meet all WellSense's behavioral health quality goals, working with the BH material subcontractor as appropriate. In conjunction with BH leadership and Public Partnerships, communicates member, program performance and operational detail to state regulators including the Massachusetts Executive Office of Health and Human Services (EOHHS), the New Hampshire Department of Health and Human Services (DHHS) and other stakeholders as appropriate.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Leads the development and implementation of clinical operations initiatives including policies and procedures, care coordination, workflow plans, intensive clinical management, activities to support quality initiatives across all products and other clinical areas as appropriate.
• At the direction of the Director of BH Programs and Strategy, independently leads new behavioral health program development and implementation.
• Serves as the BH care management subject matter expert for the health plan.
• Works collaboratively with clinical, quality and medical staff on clinical program development in behavioral health as appropriate.
• Leads and supports standardization of integrated health plan clinical processes across clinical areas and teams.
• Collaborates with other department managers and the BH material subcontractor in the planning, development and coordination of department specific and cross-functional initiatives.
• Ensures Behavioral Health care management (CM) staff has resources and systems necessary to complete job functions, and that information is documented and communicated to staff via written operational policies, procedures and related workflows
• Works collaboratively with health plan clinical teams and other stakeholders on clinical program issues.
• Works collaboratively with health plan clinical teams, BH medical staff, BH material subcontractor and other entities as appropriate on resolution of escalated member issues, to include leading state regulatory prescribed efforts related to member transition of care due to provider terminations.
• Works collaboratively with medical care management senior leadership across the BMC Health System as required and appropriate as well as other WellSense departments and providers to ensure the integration of BH and other programs and services.
• Along with BH leadership, coordinates information to EOHHS and DHHS, other state regulators and stakeholders as appropriate to demonstrate program performance and meeting member needs.
• Participates and works with BH senior leadership as appropriate in the recruitment, orientation, management, supervision and training of staff.
• Assists senior behavioral health management staff and the BH material subcontractor in ensuring the success of clinical network quality improvement initiatives.
• Provides high level of service and satisfaction to internal and external customers
• Attendance is an essential function of the position.
• Perform other duties as assigned

Supervision Exercised:

• Direct supervision of six (6) or more FTEs and indirect supervision of 10-15 FTEs if required

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education:

• Master's degree in a behavioral health field such as psychology, social work or a degree in nursing is required.

Experience:

• Minimum five to seven years' experience managing staff in a behavioral healthcare organization required.

Experience Preferred/Desirable:

• Clinical supervisory experience with a Medicaid managed care population preferred.

Certification or Conditions of Employment:

• Current certificate or state licensure in Massachusetts and New Hampshire as RN, LICSW, LMHC, Clinical Nurse Specialist, or Licensed Psychologist.

Competencies, Skills, and Attributes:

• Able to work in a fast paced environment; ability to multi-task.
• Proven leadership skills and ability to build effective teams and ability to work collaboratively with management staff in other departments.
• Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications.
• Strong clinical problem solving skills.
• Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting.
• Detail oriented and excellent analytical skills.
• Ability to work both independently and as part of a team.
• Strong oral and written communication skills; ability to interact within all levels of the organization.

Working Conditions and Physical Effort:

• Fast paced office environment
• Travel to hospitals and other Provider locations may be required.
• Work is normally performed in a typical interior/office work environment or remotely

Compensation Range

$96,000 - $139,500

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees