Manager- Clinical Programs Behavioral Health Utilization Management

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.

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.

Essential Roles and Responsibilities

People and Culture
• 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

Client Experience
•Maintain effective relationships with our clients and communicates information with respect to client expectations
• Build and manage 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 needs and address immediate member issues
• Identify and resolve problems to uphold a high standard of client and member service; Communicate emerging trends to Pod leadership for escalations as needed.
• Partner with leadership to ensure effective client implementation and keeping the Client Success 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 behavioral health 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
• Participate in the development of processes, protocols, and program design; Reinforce associated expectations to ensure consistent understanding, alignment, and application across the clinical team.
• Remain accessible to staff to answer questions and clarify expectations as needed.
• Assist with resolving escalations and addressing complex operational or clinical challenges.
•Communicates information with respect to client expectations, business results/metrics, member satisfaction and team culture
• 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

Skills and Qualifications
• Licensure: Must hold an active, unrestricted, and unencumbered professional license in good standing with the state board of licensure in one of the applicable clinical disciplines:
•    Registered nurse (RN) or Licensed Social Worker (LSW, LCSW, LISW)
•    Must hold a Multi-State License (MSL) issued through the relevant licensure compact (e.g., Nurse Licensure Compact for RNs). For clinicians in states that do not offer MSL, or for disciplines for which an MSL program has not been launched, employees must be willing and able to obtain and maintain additional state licenses as required to support members served by the organization. Both the MSL and individual state licenses must be obtained within 90 days of hire. Maintenance of required licensure, 
including timely renewal and compliance with state board regulations, is a condition of employment. 
• Minimum of 4 years of experience in a behavioral health setting, preferable within utilization management.
• 3 - 5 years of experience leading or managing a Behavioral Health team(s).
•Demonstrated ability to make timely, effective decisions aligned with business goals and organizational culture.
•Strong clinical expertise, including proficiency in motivational interviewing.
•Excellent interpersonal communication skills for effective collaboration with patients, providers, and healthcare partners.
•Outstanding computer proficiency including navigating multiple systems and Microsoft applications.
• Ability to multitask, prioritize, and adapt within a dynamic, growth-oriented environment. 
•Strong personal accountability, integrity, a commitment to upholding Quantum Health’s values, ethics, and data privacy requirements.