Manager, Clinical Teams - Behavioral Health Utilization Management - Detroit, MI

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Job Description

We're hiring a Manager, Clinical Teams for the Behavioral Health Utilization Management Team! In this critical role, you will collaborate and engage with multiple internal stakeholders and external customers (i.e. providers, vendors, employer groups) to implement population health management and promote a collaborative, integrated culture across lines of business/segments. Supports value-based strategy by leading multiple clinical or non-clinical teams/staff focused on improving member health through proactive and professional services in the following areas: clinical determinations, case management, disease management, wellness, medical policy, medical review, and/or related services.
What You'll Do

• Assist in the development of operational strategies and innovative solutions for area(s) of clinical oversight; facilitate favorable medical expense, administrative pricing and/or efficiencies.
• Maintain awareness of trends, developments, and governmental regulations in managed health care organizations and product line(s) under leadership purview and recommends associated policy positions, new initiatives and/or existing program changes to improve the company's competitive position.
• Use competitive intelligence to guide, consult and drive strategic program and product development and management
• Manage the operational performance of multiple integrated clinical functions across multiple lines of business, including Commercial, Medicare and FEP. Manage Clinical Determinations, Wellness, Medical Policy, Medical Review and/or related services for different line(s) of business to ensure performance standards are met and in compliance with employer groups, FEP Directors' Office, and/or applicable state and federal regulations.
• Initiate and manage service initiatives/programs to facilitate and promote quality, cost effective outcomes and minimize the impact of fragmented health care delivery on the customers.
• Collaborate and integrate with internal and external customers to deliver a fully integrated care delivery model and seamless member experience and to investigations or escalated/high profile cases; troubleshoot and provide guidance to staff to ensure resolutions and improved customer experience.
• AND MORE...