Program Manager - Integrated Health

Heartland East; Bartow (WV); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

tuition assistance

domestic partner coverage

retirement

generous paid time off

Job summary

Heartland for Children in Bartow, FL seeks a Program Manager - Integrated Health to oversee coordination and implementation of services for APD, mental health, substance abuse, and medical care for dependent children and families. The role operates within Sunshine Health Plan and MMA plans, ensuring contract compliance and HEDIS measures.

The position requires a Bachelor’s degree (Masters or clinical licensure preferred) and at least three years in related fields, with supervisory experience.

Qualifications

• Bachelor’s degree in social services, Health Care, Business or related field required.
• Licensed clinician and/or a Masters level highly preferred.
• Requires a minimum of three (3) years relevant post-degree experience in mental health and/or substance abuse health care, utilization management or child welfare, and previous supervisory experience in child welfare and/or mental health.

Responsibilities

• Establishes and maintains positive working relationships with HFC internal/external customers.
• Manages the integrated health department.
• Serves as single point of access for behavioral health-related issues for Medicaid and managed care plans.
• Follows all contracts and reporting requirements with the Sunshine Health Plan and Department of Children and Families and ensures HEDIS measures are met.
• Ensure that the behavioral health/integrated care team schedules the appropriate multi-disciplinary staffings for children who have been assessed and recommended for STFC; BQRTP; STGH; SIPP/ RTC and substance abuse programs
• Ensure the nurse care team schedules and manages staffings for children who have been assessed; recommended or placed in medical foster care, deemed medically complex or fragile, or who have ongoing medical or dental needs which impact their care while in the dependency system
• Responds to and assists with the management of in-patient and hospital notifications to HFC and all other appropriate parties
• Work in partnership with the MMA and the APD through the approval process for services
• Monitors the processing and tracking of medical case management referrals for assistance or referral to the MMA for medical case management
• Provide consultation to case management on preparing appropriate information, including requests for initial suitability assessments, 60/90-day assessment reviews
• Complete records review for in-state and out-of-state admission consideration into residential mental health or substance abuse treatment
• Monitor and track behavioral health referrals for higher levels of care, to include Specialized Therapeutic Foster Care (STFC), Behavioral Qualified Residential Treatment Program (BQRTP), Specialized Therapeutic Group Care (STGC) and SIPP, including the suitability assessment process
• Participate and, if needed, facilitate Baker Acts staffings for youths receiving case management services
• Provide oversight by participating in or facilitating discharge planning staffings and participating in treatment team meetings and treatment plan staffings for children who are placed in therapeutic and/or behavioral health settings to ensure ongoing authorization and/or need for ongoing funding by HFC
• Participate and attend necessary local review team, state review team, APD or other MDT related staffings, court hearings and other meetings
• Identify clinical systemic gaps and population-specific needs
• Provide telephone triage, crisis intervention, and emergency authorizations and/or resources
• Assist network development by identifying gaps in the network and quality providers
• Performs special projects as assigned

Education

Bachelor’s degree in social services, Health Care, Business or related field

Job description

Program Manager - Integrated Health

Job Summary

This is a professional management position that oversees the coordination and implementation of services for the Agency for Persons with Disabilities (APD), mental health, substance abuse, and medical care for dependent children and families in Circuit 10 under the Sunshine Health Plan and other managed medical assistance (MMA) plans.

Essential Functions

• Establishes and maintains positive working relationships with HFC internal/external customers
• Manages the integrated health department
• Serves as single point of access for behavioral health-related issues for Medicaid and managed care plans
• Follows all contracts and reporting requirements with the Sunshine Health Plan and Department of Children and Families and ensures HEDIS measures are met
• Ensure that the behavioral health/integrated care team schedules the appropriate multi-disciplinary staffings for children who have been assessed and recommended for STFC; BQRTP; STGH; SIPP/ RTC and substance abuse programs
• Ensure the nurse care team schedules and manages staffings for children who have been assessed; recommended or placed in medical foster care, deemed medically complex or fragile, or who have ongoing medical or dental needs which impact their care while in the dependency system
• Responds to and assists with the management of in-patient and hospital notifications to HFC and all other appropriate parties
• Work in partnership with the MMA and the APD through the approval process for services
• Monitors the processing and tracking of medical case management referrals for assistance or referral to the MMA for medical case management
• Provide consultation to case management on preparing appropriate information, including requests for initial suitability assessments, 60/90-day assessment reviews
• Complete records review for in-state and out-of-state admission consideration into residential mental health or substance abuse treatment
• Monitor and track behavioral health referrals for higher levels of care, to include Specialized Therapeutic Foster Care (STFC), Behavioral Qualified Residential Treatment Program (BQRTP), Specialized Therapeutic Group Care (STGC) and SIPP, including the suitability assessment process
• Participate and, if needed, facilitate Baker Acts staffings for youths receiving case management services
• Provide oversight by participating in or facilitating discharge planning staffings and participating in treatment team meetings and treatment plan staffings for children who are placed in therapeutic and/or behavioral health settings to ensure ongoing authorization and/or need for ongoing funding by HFC
• Participate and attend necessary local review team, state review team, APD or other MDT related staffings, court hearings and other meetings
• Identify clinical systemic gaps and population-specific needs
• Provide telephone triage, crisis intervention, and emergency authorizations and/or resources
• Assist network development by identifying gaps in the network and quality providers
• Performs special projects as assigned

Qualifications

Bachelor’s degree in social services, Health Care, Business or related field required. Licensed clinician and/or a Masters level highly preferred. Requires a minimum of three (3) years relevant post-degree experience in mental health and/or substance abuse health care, utilization management or child welfare, and previous supervisory experience in child welfare and/or mental health. Requires an ability to be flexible and change activities quickly.

Benefits

• tuition assistance
• domestic partner coverage
• retirement
• generous paid time off

Additional Information

Drug free workplace. Drug testing required.

EOE/M/F/D/V.

Heartland for Children does not discriminate in employment opportunities or practices based on disability, race, color, religion, sex, national origin, age, marital status, or any category protected by law. HFC will make reasonable accommodations for qualified individuals with known disabilities unless doing so creates an undue hardship for the organization.

Heartland for Children is a community-based care lead agency contracted with the Department of Children and Families.

1239 E. Main Street Bartow, Florida 33830

[phone]