Job Description

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

Position Purpose:

Under the VP of Clinical Operations, the Director of Behavioral Health will lead and oversee operations of Behavioral Health, Substance Use and Social Service (BH/SUD/SDOH) Care Management programs and has the responsibility to execute both the short and long-term Care Management goals of Steward Health Care Network

  • Responsible for performance, operations and/or oversight of daily BH/SUD/SDOH care management programs
    • Leads and manages the care management managers and staff in order to provide quality focused cost-effective interventions to all patients across the continuum of care and develops methods for provider and patient engagement
    • Oversees the day-to-day operations of the care management teams he/she is responsible for and the use of systems to identify individuals and populations at risk and/or those in need of care management services. Works collaboratively with SHCN clinical leaders in developing and implementing programs and initiatives to address those issues
    • Oversees the operations and contracts for MassHealth funded programs and initiatives, including, but not limited to: MassHealth BH and LTSS Community Partner Program and Flex Services Program, and implements internal workflows on patients served by internal SHCN CM programs and MassHealth programs
    • Oversees clinical operations and staff for Health Policy Commission (HPC) grant funded program
    • Participates and reports on designated programs monthly performance and KPI to Executive Leadership Team and identifies risks and mitigation plans to improve performance, when applicable
    • Consults on the development of care management process and outcome analysis and reporting
    • Collaborate and present to Steward and SMG PCP practices to educate providers on SHCN Care Management programs and identify workflows to drive provider referrals in to programs
    • Introduces and monitors care management tools and strategies and leverage technological solutions when possible
    • Supports SHCN efforts to meet federal and state regulations as well as health plan specific policies and procedures
    • Understands & adheres to regulatory guidelines including NCQA/CMS/URAC/ERISA
  • Process improvement
    • Evaluates processes, identifies problems, and proposes improvement strategies to enhance the delivery of care for patients throughout continuum of care
    • Monitors care management program effectiveness and efficiency and makes adjustments accordingly
    • Monitors current trends to ensure ongoing process improvement opportunities
  • Implements new clinical programs
    • Identifies and understands current opportunities for program growth and development
    • Effectively develops new programs to target opportunities for improved health outcomes and increased performance

Education / Experience / Other Requirements

Education:

  • Master’s degree, required
  • LCSW/LICSW/LMHC, preferred, not required

Years of Experience:

  • Minimum of 5 years’ relevant clinical BH/SUD/SDOH, experience, required
  • Minimum of 5 years of prior management experience in health plan, ACO and/or BH/SUD/SDOH field, preferred

Specialized Knowledge:

  • Valid driver license and insured vehicle to drive within the territory
  • Possesses strong clinical background in BH/SUD/SDOH settings with focus on the delivery of high quality and cost effective care
  • Experience working with multiple provider types along the continuum of care, such as physician groups, hospitals, home health agencies, and skilled nursing facilities
  • Demonstrates ability to problem solve and coach staff when necessary
  • Demonstrated supervisory and management skills; ability to mentor and lead a staff team
  • Excellent written and verbal communication skills; ability to interact with individuals at all levels within an organization
  • Experience overseeing clinical programs supporting patients and families with self-management.
  • MS Office, PowerPoint, MS Project, EHR, case management software
  • Thorough understanding of managed care, case management, disease management, and referral/authorization operations and principles
  • Thorough understanding of health plan and regulatory rules and policies, including NCQA and URAC
  • Recent patient care management experience, as well as excellent leadership, team building, and communication skills
  • Self-motivated and assertive

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online