Clinical Operations

• Act as a player/coach, working alongside Care Extenders (CE) to build their skills in everyday situations and to directly support members in more challenging situations or as needs arise, such as: Assess members for risk, make quick evaluations for risk, and respond within the parameters outlined within their safety plan, formulating and performing crisis intervention that ensures the safety of members as necessary to support the Care Extender team.
• Screen eligible and active members for behavioral health, medical, and social needs.
• Assist the Care Extender to prioritize needs.
• Identify members’ urgent safety needs and partner with the Care Extender and member to create a safety plan upon enrollment to be utilized during periods of crisis.
• Create service plans using all available information about the member, including screenings, conversations, data, and knowledge of community resources.
• Guide members in developing skills and/or strategies for managing problems and triggers to increase relapse prevention and reduce risk.
• Encourage members to develop work skills and to participate in social, recreational, or other therapeutic activities that enhance interpersonal skills and develop social relationships.
• Educate members about mental or physical illness, abuse, violence prevention, medication, and available community and social resources.
• Monitor, evaluate, and record members’ progress according to measurable goals described in members’ plans.
• Build accountability communications about upcoming appointments.
• Interact continuously with members, families, physicians (s), and other providers utilizing clinical knowledge and expertise to lower over-utilization of unnecessary resources.
• Request consultation and diagnostic reports from network specialists as needed to support members in reaching their goals.
• Report critical incidents and information regarding the quality-of-care issues.
• Build communication strategies to ensure the team is engaging and building relationships with the member cohort in order to support members in reaching their goals.
• Develop and coordinate the development of community resource guides with an emphasis on behavioral health, medical health, violence prevention, and social services.
• Identify the member’s behavioral health diagnoses and ensure that the member’s service plan is comprehensive and appropriate for their needs.
• Lead our Care Extender team to ensure member needs are assessed adequately and that all members have an appropriate service plan and are making consistent progress toward their goals and graduation from the program.
• Coordinate caseloads and assist in referring new members to appropriate Care Extenders.
• Ensure the team’s schedules meet program needs.
• Participate in the screening, interviewing, and hiring of new team members.
• Provide orientation and training for new team members, conduct performance reviews, and continuously coach the team to build skills and improve performance.
• Lead enrollment activities as needed to build a new market or maintain the current cohort, depending on where the program is in its lifecycle.
• Ensure the team meets all Key Performance Indicators, coaching and training the team as necessary to keep the team on track to meet/exceed expectations and deliver outcomes for individual members and health plan partners.
• Perform regular documentation reviews to ensure quality and for training purposes.
• Analyze team performance to identify gaps and challenges and create plans to improve performance as needed.
• Collect and synthesize data that highlights member outcomes to support team training, improve high-quality engagement, deepen internal understanding across markets, strengthen relationships with our partners, and enable us to continually drive toward results.
• Lead regular internal case review sessions, with individuals and with the team, for quality and training purposes.
• Participate in external case management meetings with health plan partners as needed.Perform required duties to maintain all program-related and administrative data/reports, statistical records, and other data collection activities.
• Partner with the billing team to review prepared claims to ensure they accurately reflect services provided and provide additional information as needed.

Clinical Program Manager, Suicide Prevention Program

Clinical Operations Nurse

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Clinical Quality Manager – Population Health

Senior Project Manager, Strategic Operations, Global Clinical Operations