Clinical Program Manager

Job description

Mindoula Specialty Population Health Management Program Managers lead a team of Care Extenders to implement one of our programs, serve members, and deliver outcomes to our health plan partners. Their team of Care Extenders empower members to actively participate in improving their own health and wellness through personalized case management that targets each member’s specific needs. An innovative Program Manager seeks creative solutions to support Care Extenders and program goals, leading the team toward the desired operational, clinical and financial outcomes. As the leader of a community-based team, they model a hands-on approach, empowering the team to meet members where they are and tapping into the wide range of local resources to deliver whole-person care.

Location and Hours…

This is a 100% remote position that must be located in the United States. This role manages a team that works in the western US and will need to work Pacific time zone hours. This will be Monday-Friday, roughly 8 am to 6 pm Pacific time.

What you’ll do…

• Act as a player/coach, working alongside Care Extenders to build their skills in everyday situations and to directly support members in more challenging situations or as needs arise, such as:
  • Create service plans using all available information about the member, including screenings, conversations, data, and knowledge of community resources. Guide members in developing skills and/or strategies for managing problems and triggers to increase relapse prevention and reduce risk.
  • Encourage members to develop work skills and to participate in social, recreational, or other therapeutic activities that enhance interpersonal skills and develop social relationships.
  • Educate members about mental or physical illness, abuse, violence prevention, medication, and available community and social resources.
  • Monitor, evaluate, and record members’ progress according to measurable goals described in members’ plans.
  • Build accountability communications about upcoming appointments.
  • Interact continuously with members, families, physicians (s), and other providers utilizing clinical knowledge and expertise to lower over-utilization of unnecessary resources.
  • Request consultation and diagnostic reports from network specialists as needed to support members in reaching their goals.
  • Report critical incidents and information regarding the quality-of-care issues.
• Build communication strategies to ensure the team is engaging and building relationships with the member cohort in order to support members in reaching their goals.
• Assess members for risk, make quick evaluations for risk, and respond within the parameters outlined within their safety plan, formulating and performing crisis intervention that ensures the safety of members as necessary to support the Care Extender team.
• Develop and coordinate the development of community resource guides with an emphasis on medical health, behavioral health, violence prevention, and social services.
• Identify Member’s behavioral health diagnoses and ensure that the Member’s service plan is comprehensive and appropriate for the Member’s needs.
• Lead our Care Extender team to ensure member needs are assessed adequately and that all members have an appropriate care plan and are making consistent progress toward their goals and graduation from the program.
• Coordinate caseloads and assist in referring new members to appropriate Care Extenders.
• Ensure the team’s schedules meet program needs.
• Participate in the screening, interviewing, and hiring of new team members. Provide orientation and training for new team members, conduct performance reviews, and continuously coach the team to build skills and improve performance.
• Lead enrollment activities as needed to build a new market or maintain the current cohort, depending on where the program is in its lifecycle.
• Ensure the team meets all Key Performance Indicators, coaching and training the team as necessary to keep the team on track to meet/exceed expectations and deliver outcomes for individual members and health plan partners.
• Perform regular documentation reviews to ensure quality and for training purposes.
• Analyze team performance to identify gaps and challenges and create plans to improve performance as needed.
• Collect and synthesize data that highlights member outcomes to support team training, improve high-quality engagement, deepen internal understanding across markets, strengthen relationships with our partners, and enable us to continually drive toward results.
• Lead regular internal case review sessions, with individuals and with the team, for quality and training purposes. Participate in external case management meetings with health plan partners as needed.
• Perform required duties to maintain all program-related and administrative data/reports, statistical records, and other data collection activities.
• Partner with the billing team to review prepared claims to ensure they accurately reflect services provided and provide additional information as needed.

Required Licensure, Education, and Experience:

• A Qualified Mental Health Professional (QMHP) holding one of the following licenses:
  • Licensed Clinical Social Worker (LCSW)
  • Clinical Professional Counselor (CPC) or Licensed Professional Counselor (LPC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Licensed Psychologist (PhD or PsyD), or equivalent.
• Experience leading, building and implementing programs and delivering outcomes.
• Experience with Health Coaching or Medical Social Work preferred.
• Master’s degree in behavioral health, social work or health care management from an accredited university required.

Skills Required:

• Management and compliance: Experience ensuring care is delivered according to applicable laws, regulations, policies and procedures, supporting the organization’s integrity efforts by acting in an ethical and appropriate manner and that the team is operating at a level of excellence befitting our brand.
• Relationship Management: Ability to develop, maintain, and strengthen relationships and partnerships with others inside or outside the organization.
• Problem Solving: Track record of identifying needs and taking independent action to implement change when and where it is needed; results oriented. Ability to plan, organize, manage time, and prioritize multiple tasks and assignments. Use effective follow through.
• Communication: Excellent listening, verbal and written communication skills. Strong ability to clearly and accurately, relay information to staff, business partners, stakeholders, and clients.
• Collaboration: Ability to work cooperatively and effectively with others to set goals, resolve problems, and make decisions that enhance organizational effectiveness.
• Member and Crisis Management: Ability to provide case/care management in routine and crisis situations.