Director of Children's Special Services

Job Ref: TE0103
Category: Professional
Department: MHP CHILDRENS PROGRAM
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $125,000.00 - $155,000.00

Position Overview

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Director of Children's Special Services (DCS) manages the operational, regulatory, clinical and oversight activities of the Children Special Services program. The DCS is responsible for high touch coordination between MetroPlusHealth, Health Homes, OCFS, and LDSS/VFCA. The DCS works with the Plan's Medical Director for Medically Fragile Children, the Children's BH Medical Director, and the Senior Director of Children's Special Services (SDCS) to ensure that members receive all medically necessary care, referrals to Health Homes or other child serving systems, appropriate health home coordination services, timely CANS-NY assessments, and appropriate HCBS services.

Scope of Role & Responsibilities

• Responsible for the overall operation ofMetroPlusHealth's Children's Special Services Unit.
• Responsible for oversight of the Physical and Behavioral Health Utilization Management and Care Management for Children's special populations including HCBS eligible members 0-21 years, children/youth placed in foster care, medically fragile children, children with complex medical, behavioral, and/or developmental issues.
• Provision of clinical oversight and leadership to UM/CM staff working with the children's population.
• Development, implementation, and interpretation of clinical-medical policies and procedures (P&Ps) that are specific to the benefits and services of this transition or can be expected to impact the overall health, recovery, and wellbeing of children.
• Oversight of the Foster Care carve-in & readiness review, development, and ongoing oversight of care management of the Foster Care population
• Oversight of the Children's BH carve-in & readiness review, and development and ongoing oversight of care management for children's BH needs
• Ensures the provision of Behavioral Health services, Health Home coordination and needed HCBS services to members.
• Ensuring strong collaboration and coordination between other child-serving systems, including the education system and foster care system.
• Ensures strong collaboration and coordination between BH and PH care across the UM/ CM staff.
• Clinical peer review recruitment and supervision.
• Works with the MetroPlusHealth Quality Management department on quality improvement projects, Performance Improvement Plans and relevant HEDTS and QARR activities.
• Development and implementation of the BH sections of the QM/UM Plan, including having the BH Medical Director for Children's Services and participate on the BH committees for QM/UM.
• Administration ofBH QM/UM and performance improvement activities, including grievances and appeals.
• BH provider quality profile design and data interpretation.
• Responsible for timely and accurate reporting to the Children's Advisory Committee, MetroPlusHealth UM Subcommittee, MetroPlusHealth BH Core Subcommittee, and MetroPlusHealth UM Subcommittee.
• Ensures that the UM and Children's Special Services clinical team comply with UM requirements for the medically fragile population set forth by the "Office of Health Insurance Programs Principles for Medically Fragile Children".
• Works with MetroPlusHealth customer service to ensure the proper enrollment/disenrollment of children in Foster Care.
• Oversees Health Home assessment and assignment activities.
• Sets program goals and implements continuous improvement activities to achieve them.
• Ensures the monitoring of care coordination, CANS-NY assessments and HCBS services provided by Health Homes and HCBS providers.
• Works with IT, Core Configuration, Claims, Provider Contracting, and other internal departments to ensure smooth operations of the unit.
• Collaboration with Provider Relations staff to ensure an adequate provider network via required provider credentialing guidelines
• Attendance at regular (at least quarterly) Plan leadership and medical director meetings.
• Attendance at Regional Planning Committee and other meetings as identified by the State to promote community stakeholder involvement in shaping the system of care for children.
• Partner with Project Teach Statewide Coordination Center on an annual basis to support the promotion of pediatrician access and consultation to a child and adolescent psychiatrist.
• Perform other duties as assigned.

Required Education, Training & Professional Experience 

• Master's Degree in a behavioral health-related major; higher degree preferred
• Must have at least seven years of experience in a BH managed care setting or BH clinical including setting, including:
  • At least two years of managed care experience (preferably Medicaid managed care) and
  • At least five years of experience working with children; or
  • An equivalent combination of education, training and experience, knowledge, and skills sufficient to indicate ability to perform satisfactorily
• Must have thorough knowledge of the Medicaid Managed Care Organization Children's System Transformation Requirements and Standards.
• Experience working with Health Homes.
• Knowledge of QM, UM activities, and reporting.
• Clinical experience, a plus.

License and/or Certification Required

• Valid New York State license and current registration to practice in a behavioral health profession as issued by the New York State Education Department (NYSED). Examples of acceptable licensure include Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), and Licensed Mental Health Counselor (LMHC)

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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