The Behavioral Health (BH) Pediatric Care Management (CM) Director is a key member of the Behavioral Health Children’s Services leadership team. The Director, BH Children’s Care Management Services, monitors the clinical functioning of the Children’s Services program model and provides oversight of the case management teams’ activities, leverages industry standards and best practices in behavioral health service delivery to drive innovations in behavioral health CM. This role oversees BH CM staff for all pediatric lines of business and behavioral health services. The Peds BH CM director supervises, analyzes, and coordinates Behavioral Health daily activities to ensure that departmental productivity goals are met regarding quality care, compliance, and clinical coordination. This includes management of the Children’s teams, as well as developing efficient and effective service delivery systems that will ensure a high level of quality care and compliance. This position creates and implements programs that target and support integrated care for our members under the age of 21.

The position takes a lead role in pushing company practices toward more effective coordination of care; liaising with our provider community in order to do so. The position identifies, gathers, and analyzes various data points to successfully implement BH CM policies, aligns with BH and Medical Pediatric UM, and BH Adult CM to the extent possible to ensure ongoing effective program functioning.

A leader at Healthfirst dynamically engages with abstract ideas or situations across functional areas of the business. Through assessment of key delivery system variables, this position will identify and evaluate fundamental issues, providing strategy and direction for functional integration of complementary business areas. This position requires in-depth knowledge of the Children’s Behavioral Health service system, core integration strategies, and the company’s strategic goals.

Duties/Responsibilities:

• Provides leadership and directs the home and community-based services (HCBS) and case management program of the Children’s Services unit for Healthfirst members ages 0-21.
• Participates in all aspects of the team’s management and employee lifecycle to ensure appropriate talent management.
• Ensures a team atmosphere that fosters open communication, collaboration, ownership, and empowerment to make decisions
• Ensures guidelines as mandated by CMS and NY State regulations, job aides, and HF policies are followed. This includes review of individual and aggregated CM performance audit results in order to maintain superior and accurate care data for each HF member
• Participates actively in strategic planning for BH department clinical operations including special projects and pilots
• Represents Healthfirst at city and state meetings, external presentations, and provider forums to educate and build collaborative relationships
• Oversees children’s behavioral health initiatives and direction that support safe, aggressive treatment resulting in quality outcomes and cost-effective care
• Addresses issues identified by internal risk assurance functions including but not limited to fair hearing process, SIU, etc.
• Demonstrates proficiency in reviewing and analyzing utilization and productivity data and flexibility in managing to report results
• Uses data to optimize BH Care Management department integration and operations including workflows; policies and procedures; utilization management practices; and quality monitoring
• Identifies key improvements that will advance operations and further the seamless integration of the behavioral health and general medical teams
• Performs other duties as assigned

Minimum Qualifications:

• Bachelor’s degree from an accredited institution
• Current License/Certification as Behavioral Health Professional, such as Psychologist, Social Worker or Licensed Mental Health Counselor (i.e., LCSW, LMHC, LMSW, PhD, PsyD.)
• Seven years of experience in a BH managed care setting or BH clinical setting, including at least two years of managed care experience (preferably Medicaid managed care) and at least five years of experience working with children
• Demonstrated effectiveness with written and oral communication
• Demonstrated effectiveness of interpersonal skills and the ability to work effectively at all levels in a collaborative team environment

Preferred Qualifications:

• Master’s degree from an accredited institution
• Knowledge of the various child serving systems in NYS
• Knowledge of NYS Medicaid Program
• Experience in strategic development and operational management in a managed care organization with a focus in Behavioral Health
• Prior work experience in education
• Experience with clinical operations, clinical quality, quality assurance and/or project management
• Experience working with high performing, cross functional teams
• Sound organizational skills with the ability to handle multiple tasks and prioritize appropriately
• Flexible, adaptable, and excellent problem-solving skills with a proven track record for driving results

Since we care so greatly about our employees' and members' wellbeing, Healthfirst has implemented various COVID-related health and safety requirements for our workforce. Employees are expected to follow the Company’s current COVID-19 or other infectious disease health and safety protocols, including local requirements, which may include sharing information regarding your vaccine status and mask wearing. Protocols may change in the future with the evolving public health landscape. Healthfirst will consider accommodation requests as required by applicable law.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $176,525 - $225,080

• All Other Locations (within approved locations): $121,400 - $185,725

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.