Program Supervisor - Managed Care

Hires, develops, trains, manages, and retains program staff and team(s) to ensure customer satisfaction and culturally competent service delivery consistent with managed care requirements. Functions as the liaison between team, agency, and community partners. Ensures provision of high-quality service by program staff through administrative supervision and monitoring of program KPIs.

• Clinical Care Management
• Works with Program Manager to ensures effective quality managed care services delivery for assigned health plan members.
• Ensures and monitors satisfaction and defined outcome achievement for health plan members.
• Collaborate with licensed staff to provide effective crisis and risk prevention and management.
• Provides 24/7 availability as needed. Culturally responsive to internal and external customers and ensures customer voice.
• Provides direct services to health plan members, as support to the direct service staff, to ensure smooth delivery of service.
• Responsible for managing referrals (e.g., electronic, telephonic, manual) and assigning accordingly
• May be responsible for case load.
• Ensures customer voice and is culturally responsive to internal and external customers.
• Consults with clinical and medical staff about treatment plans, youth and family issues, progress and needs.
• Program & Fiscal Management
• Oversees and supports the assessment process and implementation of treatment plans consistent with managed care requirements.
• Manages day-to-day provision of services of team members (e.g., System Navigators).
• Work with Program Manager to ensures staff engage health plan members for enrollment and other revenue related activities meet or exceed revenue forecasts to ensure viable programming.
• Ensures compliance with all policy and procedures including adherence to all licensing, quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards.
• Oversee clinical documentation meets both agency and payor standards, ensuring audit ready charts and continuous quality improvement.
• Effectively manage individual and program utilization rates.
• Responsible for managing team operation metrics at appropriate frequency to effectively manage the program, staffing pattern, and clinical needs.
• Works collaboratively with managerial peers to develop and improve program delivery and ensure adherence to fiscal requirements.
• Personnel Management.
• Participates in staff development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and terminates.
• Leads and manages change.
• Proactively identifies potential conflicts and facilitate resolution
• External Liaison
• Work with Program Manager to ensure effective coordination of services for health plan members with other providers, both internal and external, by supporting the development of constructive relationships and problem-solving barriers.
• Provides outreach to the community regarding managed care and behavioral health.
• Quality Assurance and Improvement
• Initiates and participates in organizational quality improvement efforts. Lead and/or delegate work groups to respond to program development needs.

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions.
• Bachelor of Arts or Science (B.A./B.S.) in related field and 1 (one) or more years of relevant experience required, or equivalent combination of education and experience (two years of relevant experience equals one year of education) to include:
  • Minimum of one (1) year of experience in primary care, public health, social or mental health services delivery.
  • Knowledge of whole-person or integrated care.