Director of Community/Clinical Systems Integration

ValueOptions, one of the nation?s largest managed behavioral healthcare companies, is seeking a career oriented Director of Community/Clinical Systems Integration professional for its Gainesville, Florida office.

 

The Director of Community/Clinical Systems Integration will be

responsible for successful implementation and operation of the Value Options MCO services for the Medicaid Prepaid Mental Health Program (PMHP). This position must assure that all functions are performed according to the contract. This position provides leadership for applying managed care principles, strategies and best practices to PMHP operations. The position also involves participation and leadership in community meetings and initiatives to develop linkages, coordination and collaboration with community organizations. In addition, this position conducts on-site medical record reviews and analysis of data to evaluate clinical care and provider performance. Identifies quality of care issues and best practices and makes recommendations to the Regional Management Team.

1. Coordinates VO managed care functions with provider operations in applicable Prepaid Mental Health Plan (PMHP). Supports contract oversight to assure that Medicaid contract requirements are met in assigned PMHP Area.

2. Assumes a key role for PMHP implementation activities and special initiatives.

3. Participates on the PMHP Regional Council, Clinical Advisory Committee, and Quality Committee.

4. Provides consultation and training to providers and applicable community and stakeholder groups regarding contractual requirements, managed care principles, strategies, techniques and best practices, and systems integration.

5. Develops and maintains collaborative agreements with community organizations that also serve PMHP consumers. Completes related contractual requirements.

6. Represents PMHP at high level community planning forums that seek to enhance the availability, integration and effectiveness of a broad range of health, education, criminal justice and social services.

7. Facilitates ValueOptions managed care services for applicable contract and formulates any action plans required by internal and external audits.

8. Provides a leadership role in promoting PMHP system integration initiatives and activities.

9. Participates in TRSC Management Committee and provides operational reports regarding assigned PMHP area.

10. Conducts on-site medical record reviews and analysis of data to evaluate clinical care and provider performance. Coaches providers when areas are found to be out of compliance with standards. Requires extensive travel throughout central Florida (Gainesville, Ocala, Leesburg).

11. Participates in risk management activities for the service center by identifying clinical issues such as quality of care, coordination or care and continuity of care concerns.

12. Collects and analyzes performance data to identify quality of care and compliance issues; assists with developing and monitoring corrective action plans.

13. Assists in the preparation of required reports for the quality improvement department, including writer summaries for quality and clinical initiatives.

14. Identifies opportunities, threats, and strategic issues in assigned geographic area (Gainesville, Ocala, Leesburg).

15. Other duties as assigned.

 

 REQUIREMENTS

Position based in Gainesville-Ocala-Leesburg, FL

Education: Terminal degree in a behavioral health related field.

Licensures: Licensed mental health professional, e.g. Registered Nurse, Clinical Social Worker, or Mental Health Counselor

Relevant Work Experience: Public sector behavioral health care delivery systems. Behavioral health managed care operations. Contract management experience. Excellent verbal and written communications ability. Effective public speaking ability. Demonstrated ability to effectively apply managed care principles and strategies to public sector operations. Operational understanding of managed care functions including: account management; care management; appeals; claims processing; eligibility; quality management; underwriting and medical budgets; risk contracting; risk management strategies; operations planning, organizing and implementation; provider relations; network development, credentialing and contracting. Effective problem solving and consensus building. Effective public relations skills.

Minimum of three (3) years experience in mental health care with two additional years of experience in quality improvement, risk management, or managed behavioral healthcare experience.

Knowledge of quality improvement procedures, managed care, and accreditation standards (CARF, URAC, JCAHO, HCFA).





ValueOptions offers a competitive benefit and compensation package and opportunities for professional and personal growth. 

 

Interested candidates should apply online at the following URL:

https://v2.projectix.com/fhc/jobboard/redirect.aspx?__JobID=17291

 

or through ValueOptions website at:

www.valueoptions.com

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