Program Manager Clinical, Consultant

Your Role

The Care Management team meets the member where they are, understandings the member’s goals, offers assistance, provides education, and recommends resources to improve member health. The Program Manager Clinical, Consultant- QI & SUD will report to the Senior Principal, Clinical Program Manager, Care Management. In this role you will implement new clinical programs which includes detailed project planning and oversight. Guide medical case managers working with members with chronic pain. Assess members with potential substance use disorders, make SUD treatment recommendations, and assist with finding optimal treatment placement for members. Work collaboratively with the behavioral health care management department. 

Your Work

In This Role, You Will:

• Provide overall program leadership, guidance, and manage all aspects of a given program, including requirements gathering, business case creation, and implementation  
• Provide steady leadership in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model
• Review program budget variance and scope change requests, and participate in the budget-resolution process  
• Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders   
• Support and coach project managers within the program, while providing technical expertise in planning, execution, and leadership of program, projects, and initiatives  
• Plan and implement multiple and complex projects/programs spanning across business areas
• Remove barriers for members seeking care, collaborate with other departments as needed
• Guide case management staff in optimal care planning for members
• Work closely with medical case manager, behavioral health case manager, and leadership to coordinate optimal care for members 
• Assess individuals with possible substance use disorders, aid in motivating members to seek treatment
• Apply knowledge of substance use disorder criteria to refer members to the most appropriate level of care 
• Find substance use facilities accepting new clients as needed, collaborate with provider contracting as needed

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires RN, LMFT, LPCC, PSYD licensure or similar by the Board of Registered Nursing or Board of Behavioral Sciences
• Requires at least 2 years working for a managed care organization (health plan, accountable care organization, etc.)
• Requires direct patient substance use disorder treatment experience 
• Requires experience collaborating with substance use disorder facilities for member placement
• Strong analytical, problem solving and communication skills preferred