Department
Clinical

Supervisor/Report
Director of Clinical Management

Job Description
The Clinical Manager is responsible for overseeing and monitoring the day-to-day workflow of the UR and CM functions on site at the Boston office. The Clinical Manager will be a resource person to team members and Plan case managers, providing support and assistance in application of Beacon’s level of care criteria, scheduling, answering questions about policies and procedures and being available to handle and train staff on difficult calls. The Clinical Manager, in conjunction with the Director of Clinical Management and local office leader (LOL), will identify training needs for other staff members, assist the clinical department in reaching contractual goals, performance objectives and support the organizational goals of customer service, efficient utilization management, organizational competency and value added case management. The Clinical Manager will be located at the Boston site.

Primary Responsibilities

1. Assists with overseeing daily workflow of UR Team members
2. Serves as immediate resource to the Team to assist with problem-solving
3. Weekly individual and group supervision of Team
4. Assists staff in the application of level of care criteria as it applies to specific product lines
5. Thorough knowledge of the covered benefits for each of the client’s Plans
6. Thorough knowledge of Beacon’s level of care criteria and case management protocols
7. Assists and trains clinical staff in handling difficult member/provider calls
8. Participates in meetings as assigned
9. Secondary contact for Plan contract leads
10. Supervisory coverage
11. Administrator on call duties (AOC)
12. Participation in NCQA and URAC activities, as assigned
13. Other duties as assigned

Scope
Non-certifications may not be issued on initial review, and always require consultation with a Physician or Psychologist Advisor

Experience/Education
Licensure for independent practice required with proof on date of hire. Re-verification will take place no less than every 3 years.
A minimum of LICSW, LCSW, LMFT, RN, LMHC, MSN. Supervisory experience and 3-5 years managed care experience required.

Supervision Exercise
At least weekly or as needed for Urgent Team members

Supervision Received
Weekly or as needed

Working Condition
General office environment. May require time commitments beyond 40 hours per week at times.

Job Classifications
Exempt