SUD Clinical Manager
About The Position
NorthCare Network is a Specialty Prepaid Inpatient Health Plan (PIHP) located in Marquette, Michigan and is responsible for the management and service array available to residents of Michigan’s Upper Peninsula with behavioral health needs covered by Michigan Medicaid and specialty grants for substance use disorder services. RESPONSIBILITIES INCLUDE: Under the supervision of the SUD Services Director, this position oversees clinical programming and serves as a liaison for the Provider Network. The SUD Clinical Manager is responsible for clinical leadership within NorthCare Network for substance use disorder (SUD) managed care services and supervising SUD Access staff. The position requires extensive involvement with the SUD Treatment Providers in the NorthCare Provider Network. This position oversees SUD treatment service delivery, ensures adherence to clinical and regulatory standards, ensures treatment services are provided according to ASAM criteria, and writes directives/policies as needed. This employee shall also participate in the development of practices that conform to regulatory standards and implementation of Quality Improvement and Utilization Management plans throughout the Prepaid Inpatient Health Plan (PIHP) region. This position evaluates medical necessity of treatment and determines authorizations for type and level of care and will provide clinical consultations for other clinicians conducting required Managed Care functions.
Requirements
- Master’s Degree and Licensure in Human Services field required.
- Minimum 3 years of experience working in a Human Services field required.
- MCBAP (CCS level) or UMICAD certification required or must be obtained.
- Experience working with substance use disorders and utilization management is required.
- Knowledge preferred in the following areas: MDHHS managed care plan, managed care procedures (authorizations, claims management, clinical best practice guidelines), CMS waiver in Michigan, Balanced Budget Act, Deficit Reduction Act, CMHSP/SUD System in Michigan, Managed Care Practices and Medicaid Regulations.
Nice To Haves
- Three years of management and/or leadership experience is preferred.
Responsibilities
- oversees clinical programming
- serves as a liaison for the Provider Network
- responsible for clinical leadership within NorthCare Network for substance use disorder (SUD) managed care services
- supervising SUD Access staff
- oversees SUD treatment service delivery
- ensures adherence to clinical and regulatory standards
- ensures treatment services are provided according to ASAM criteria
- writes directives/policies as needed
- participate in the development of practices that conform to regulatory standards and implementation of Quality Improvement and Utilization Management plans throughout the Prepaid Inpatient Health Plan (PIHP) region
- evaluates medical necessity of treatment and determines authorizations for type and level of care
- provide clinical consultations for other clinicians conducting required Managed Care functions
Benefits
- Competitive Wage, plus full-time benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
