Clinical Operations Administrator
Agency Name: Detroit Wayne Integrated Health Network
Agency Contact: DWIHN Human Resources
- Position Type: Full Time
- Job Type: Permanent
- County: Wayne
- Salary Range: Commensurate with Experience per Year
- Send applications to: https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=46595d30-595a-4b2b-9a9e-936f8beff433&ccId=19000101_000001&type=MP&lang=en_US
- Please include your resume when applying.
The Clinical Operations Administrator works under the direction of the Chief Clinical Officer and assists the administrative and clinically related duties and responsibilities associated with Utilization Management, Residential Services and Access & Crisis, specifically in the overall planning, development, and implementation of the programs, policies, procedures and operations within the Clinical operations identified by the Chief Clinical Officer.
The Clinical Operations Administrator has the administrative and clinical task to manage the administrative policies, process, and reports. This includes the following:
• Assess, plan, implement and evaluate the clinical operations, specific clinical programs, and service areas related to Residential, Utilization Management and Access/Crisis department under the direction of the Chief Clinical Officer (CCO).
• Develop and implement programmatic plans, including performance improvement activities and compliance with current regulations.
• Communicate with staff, physicians and administration both written and verbally.
• Assist in the development and administration of comprehensive Behavioral Health managed care policies, procedures and reporting that support NCQA and the organization overall mission, philosophy, and goals.
• Provide clinical oversight to ensure Behavioral Health Services clinical operations are inclusion of the continuum of care from a managed care prospective: providing departmental guidance in accordance with the organizational and departmental goals and objectives.
PRINCIPAL DUTIES AND RESPONSIBILITIES
• Under the direct guidance of the Chief Clinical Officer, the Clinical Operations Administrator is responsible for the day-to-day administrative policies and process as well as the implementation Manager of Behavior Health Organization as prescribed by NCQA.
• Assists in the assessment of community needs and works through various administrative and professional staff to develop and monitor managed care programs in Detroit and Wayne County.
• Advises and assists the Chief Clinical Officer in making policy recommendations to the DWIHN Board and Executive Leadership Team.
• Work collaboratively with Chief Clinical Officer and Chief Medical Officer to ensure the specialty behavioral services and supports are clinically appropriate based on established medical necessity criteria.
• Work on contractual regulations to develop and execute report metrics in regards to NCQA.
• Provide oversight of clinical services contract POLICIES, PROCEDURES, REPORTING, monitoring and evaluation.
• Collect and analyze data for demonstrated efficacy of managed care system integration and new programs / processes and thereby identify opportunities for improvement and growth.
• Assist CCO in the preparation and facilitation of collaborative meetings and oversee the sharing of data between the clinical and administrative units in order to maximize coordination of care and effectively manage overall costs of care.
• Performs administrative duties in the planning and coordination of programs appropriate for stakeholders as well as evaluates existing programs to determine if the need for services are met.
• Assist in developing administrative policies and procedures and interpret program goals.
• Provide technical assistance and consultation to leadership and staff within the organization, Provider Network and Audit Teams by coordinating reporting, problem solving, and coaching.
• Demonstrate knowledge and skills in the effective and efficient use of human, technical, and financial resources of the organization.
• Demonstrate an applied commitment to the values as well as knowledge and skills in consumer-oriented practices as well as innovations in support, service, treatment, and care practices.
• As instructed by the Chief Clinical Officer or Chief Network Officer, assume leadership, coordination, and/or otherwise participate in special projects and other assignments.
• Additional duties, as assigned.
• Required to have LMSW – Master Level in Behavioral health discipline: social work, counseling, psychology and direct experience working as a post graduate – Master’s Level Clinician in commercial and public managed behavioral health care.
Training Requirements (licenses, programs, or certificates):
• Must have a valid Michigan State Clinical License required (LMSW, MA).
• Must adhere to training requirements to maintain professional licensure and credentialing as a Qualified Mental Health Professional (QMHP), Child Mental Health Professional and Qualified Intellectual Disability Professional (QIDP).
• Public and Commercial Behavioral Health Managed Care is required with a minimum of ten (10) years’ experience with at least three (3) to five (5) years in areas such as utilization management, related to crisis, access community mental health service delivery, and program direction.
• Must have eight (8) or more clinical experience in a behavioral health setting required, preferably in an inpatient setting, with demonstrated program development
• Must have minimum of five (5) years administrative management experience with Behavioral Health Care programs in a managed care setting and public health.
• Demonstrated experience and success in the obtainment of accreditation, i.e., NCQA and experience MDHHS Certification review.
• Must have working knowledge of NCQA, Michigan Mental Health Code, Medicaid Provider Manual, and practice standards.
• Must have knowledge of the continuum of care for behavioral health treatment.
• Must have excellent verbal, written, and management skills.
KNOWLEDGE, SKILLS, AND ABILITIES (KSA’S)/CORE COMPETENCIES
• Knowledge of public mental health service delivery systems in Detroit and Wayne County.
• Ability to recognize and analyze complex operational/administrative or fiscal problems, and to recommend and implement solutions.
• Ability to work in an environment that resolves problems, and implement solutions in an environment that fosters continuous improvement.
• Ability to initiate, plan, develop, coordinate and implement system wide programs.
• Highly effective project management skills.