Business Administrator

Responsibilities

• Collaborate closely with the Medical Director and Fund Management to ensure that operational goals are effectively implemented and achieved.
• Supervise Social Workers

o Manage and hire direct reports in accordance with Human Resources guidelines; coach, evaluate and oversee staff development.

o Oversee Member Assistance Program functions, including job jeopardy, and onsite institutional crisis management

o Oversee the development and implementation of new Emotional Wellbeing workshops.

o Ensure activities and programs are in compliance with the SPD, DOL and clinical policies and procedures.

• Oversee Behavioral Health Utilization Management

o Manage prior authorization programs, including In-patient, IOP, PHP, TMS reviews

o Review and respond to appeals.

• Oversee Behavioral Health activities

o Assist in developing strategic plan by partnering with Medical Director and Fund’s management to identify opportunities and programming that would have direct impact on clinical and financial outcomes.

o Develop and implement policies and procedures; monitor quality assurance; identify opportunities for performance improvement and enhanced efficiencies in departmental workflows.

o Coordinate activities and collaborations between the clinical programs at the Fund.

o Collaborate with internal Fund departments, such as Claims, Member Services, Outreach, Care Management, Clinical Compliance, Provider Relations, HCADs and external stakeholders, such as Union representatives, EAPs, vendor programs (Teledoc, Medecision, etc..) to support the daily operations and to ensure best possible clinical outcomes for members.

o Ensure timely submission of all the clinical data. Coordinate and facilitate transition of the current data collection and reporting programs onto a new platform, as needed.

• Perform additional duties and special projects as assigned by management

Qualifications

• Master’s Degree in Social Work required; New York State License (LCSW) required
• Must have a minimum of ten (10) years of experience in Behavioral Health (BH) and/or Employee Assistance Program (EAP) is required, including at least five (5) years of progressive leadership and management experience.
• Must have thorough knowledge of the principles and concepts of behavioral health practice, including diagnosis and treatment, is essential.
• Understanding of the overarching guidelines for prior authorization related to the Fund and benefits, as well as New York State and national guidelines, is necessary.
• Proficient understanding of Milliman Guidelines and mandates related to Behavioral Health (BH) and prior authorization, including familiarity with the appeals process.
• Experience in writing appeals for Behavioral Health
• Experience with QNXT and V3
• Knowledge of 1199 Benefit and Pension Fund Departments preferred
• Flexible and able to work effectively in a fast-paced environment, multitask, meet deadlines, and follow through on assignments.
• Excellent problem-solving, interpersonal, organizational, verbal and written communication skills required as well as an ability to foster good working relationships with staff, management, union, employers and other professionals.
• Excellent time management and project management skills