Manager, Behavioral Health Utilization Management - New York

Primary Responsibilities

• Oversee utilization management for diverse populations, including adults, adolescents, children, and dual-eligible Medicare/Medicaid members with SMI, SUD, and co-occurring behavioral and physical health conditions
• Manage and be accountable for professional employees and supervisors
• Set team direction, resolve problems, and provide guidance to members of team
• Adapt departmental plans and priorities to address business and operational challenges
• Influence or provide input to forecasting and planning activities
• Oversee new product implementations
• Initiate processes for state initiatives and directives
• Update and create Quick Reference Guides
• Oversee and coordinate care with internal and external partners
• Interface with regulatory agencies
• Interview, hire, and onboard new employees
• Review reports to ensure team member adherence to established benchmarks
• Foster relationships with leadership and medical directors
• Cover for management team as needed

Required Qualifications

• Licensed Clinician in the State of New York with one of the following licenses: LCSW, LMHC, LMFT, LP
• 6+ years of Behavioral Health experience including Mental Health and Substance Use Disorders
• 5+ years of utilization management experience including prior authorizations, concurrent reviews, appeal processes, and UM tools related to level of care determinations and medical necessity (i.e., LOCUS, CALOCUS, LOCADTR)
• 5+ years of experience working with the under-21 population
• 5+ years of experience working with the adult population
• 3+ years of experience managing people in a Behavioral Health setting (i.e., hospital, MCO, mental health clinic), including performance reviews
• 3+ years of experience with New York public and commercial mental health and substance abuse services delivery system
• Experience overseeing documentation in Electronic Medical Records (EMR)
• Experience with Medicare and NY Medicaid products and regulations
• Experience interfacing with regulators during audits
• Intermediate proficiency in Microsoft Office Suite, including MS Excel
• Dedicated, distraction-free workspace and access to high-speed internet in home
• Residency in New York

Preferred Qualifications

• Experience working in a Managed Care Organization (MCO)
• Experience working with the New York provider network
• Experience managing clinical and non-clinical phone queues
• Experience managing a remote team
• Experience or familiarity with case management services
• Knowledge of evidence-based practices and procedures
• Demonstrated competence in clinical care management, solid leadership and organization skills, interpretation of State and federal laws, and regulations relevant to the mental health program area
• Solid customer service orientation

Pay

The salary for this role will range from $91,700 to $163,700 annually based on full-time employment.

Benefits

We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Equal Opportunity Employer

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.