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OUR TEAM

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Administration:

 

• Supports Executive Management Team with daily operations

• Coordinates and acts as liaison between the BH-MCO, County Staff,

   Corporate Board of  Directors, HealthChoices Team Leaders and the Office of Mental               Health and Substance Abuse

• Administers the overall function of the Corporation

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Operations:

 

• Assists in identifying and defining special projects and initiatives based upon Member and County need, as well      as upon changing State, Local and Federal Initiatives and requirements

• Develops plans for project development and implementation, which utilize and coordinate the resources and          expertise within the agencies Clinical, Information Technology (IT) and Financial Departments

• Assists Executive Director with County specific priority identification & planning, as well as organizational            strategic planning

• Coordinates efforts, tracks progress and works to identify and resolve any issues, tracks projects after                        implementation to assure customer satisfaction as well as outcomes

• Coordinates with committees, SBHM management team, BH-MCO, Counties and the SCA's in the                           development, review and approval of projects and initiatives

• Identifies, coordinates and facilitates training opportunities for County, SCA and provider staff to ensure                 information on new practices, promising programming and best practice models is available across the region

• Develops, plans, writes and coordinates all aspects of past and current reinvestment plans with Counties and          SCAs

• Applies for grants and other funds that may be applicable to proposed projects

• Provides Identifying, planning and coordinating necessary training opportunities to enhance the quality of the         current services to members, both internally and externally

• Provides a wide range of management and administrative support activities in the day-to-day resolution of               corporate operational issues

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Finance:

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• Fiscal responsibility for the HealthChoices program and funding

• Oversees claims payable, statistical analysis, administrative expenses and cash management

• Responsible to adhere to the financial reporting requirements and accuracy of financial               report for the HealthChoices program

• Adheres to risk compliance requirements for the primary contract

• Rate development and ongoing analysis of current rate structure to ensure adequate program    funding

• Maintains financial reporting software unique to the SW6 counties

• Reviews and coordinates responses to all DHS financial correspondence

• Responsible for the SBHM Corporation financial and human resource activities

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Information Technology:

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• Ensures that the BH-MCO maintains a comprehensive Management Information System to support the data integrity established by the Pennsylvania Department of Human Services

• Responsible to adhere to the data reporting requirements and accuracy of DHS required reports for the HealthChoices program

• Develops and monitors HIPAA compliance policies and procedures

• Maintains functional WAN/LAN and remote access network

• Maintains data security procedures and emergency disaster plan

• Provides oversight on information system solutions between provider network and BH-MCO
• Performs Business Process Reporting and Analysis of SBHM, Inc. Triage Process; coordinates monthly triage meetings with county personnel and monitors cost driver utilization

• Provide technical assistance and training to counties

• Maintenance and production support of our corporate data warehouse; develop data collection instruments and utilizes instruments and methods for the evaluation and quality control of research or operational data and collect, analyze, interpret, and summarizes data in preparation for generation of statistical and analytical reports

• Develop and maintain high quality, recurring dashboards and reports for internal and external stakeholders

Quality:

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  • Develops and administrates quality management planning for the HealthChoices contract

  • Ensures the compliance of the BH-MCO Quality Management Program with the HealthChoices contract through routine review of all BH-MCO submissions and auditing of BH-MCO processes

  • Reviews and resolves quality of care concerns

  • Participates in and coordinates with all statewide quality management studies/projects on performance improvement initiatives

  • Develops and implements quality improvement planning within the counties

  • Tracks and reviews critical/adverse incidents

  • Ensures adherence to the Healthchoices Contract with regards to member rights, dissemination of information, handbooks, telephone lines and access, notification of changes, public education programs and materials, etc.

  • Provides for member feedback and input through Member Advisory Committees and member representation on oversight committees and workgroups and complaints and grievances committees

  • Ensures compliance with Healthchoices contract regarding all denial, complaints and grievances processes

  • Facilitates grievance and level 2 complaint committees

  • Ensures adherence of the BH-MCO Compliance Program with the Healthchoices contract and BPI standards

  • Serves as Primary Contractor Compliance Coordinator

  • Ensures adherence to all Healthchoices contract and program standards, regulations and appendices through a compliance and continuous quality assurance process. Reviews Policies and Procedures. Administers and follows up on corrective action when necessary

  • Assists families in navigating the Healthchoices system and services (NWBHP Family Advocate)

  • Administrates school-based programming for the NWBHP

  • Participates in the planning and development of clinical programming at the State and County levels

  • Monitors member geographical access to services and develops strategies to meet access needs

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