Behavioral Health Practitioner, Program and Case Manager

Oscar Health
Published
October 30, 2019
Location
Phoenix, AZ
Job Type

Description

About The Role

The Behavioral Health Team is responsible for developing, coordinating and executing a company-wide approach for the Oscar behavioral health benefit and care delivery. As the Behavioral Health NP you will support both the clinical case management program, as well as program development and ongoing operations—providing clinical perspective and a systematic approach for behavioral health-related operations. You will have the opportunity to critically evaluate data and drive the incorporation of clinical perspectives into our analytical tools. Your Behavioral Health team will advocate for its members in a significant and meaningful way to help them better navigate the healthcare system- from hospital discharge coordination to longer-term care management support. You will leverage your clinical judgment, empathy, and problem-solving skills to ensure the best outcome for each member.

Clinical Operations

Responsibilities:

  • Provides clinical leadership in behavioral health and serves as a company-wide resource for all behavioral health related member or provider issues.
  • Develop and implement Oscar clinical policies, procedures and workflows for both Commercial and Medicare Advantage lines of business - ensuring compliance with both state and federal rules and negotiated contract requirements.
  • Responsible for overseeing and ensuring integration of behavioral health into all functional areas of the health plan, including establishing procedures for behavioral health’s integration with medical care and pharmacy.
  • Resolve escalated behavioral health issues from concierge staff and triage appropriately and see to resolution.
    • Work with non-clinical teammates in assisting your members navigate the healthcare system
    • Communicate with your members via phone or secure messaging using your clinical expertise in an unscripted way to provide education on health conditions, new medications, and procedures
    • Coach your non-clinical teammates on how they can help you add more clinical value to all our member interactions
    • Assist in the coordination of care across a variety of settings (outpatient, Inpatient, Residential Treatment) while maintaining strict confidentiality and the highest level of professionalism
    • Actively reach out to members undergoing difficult health challenges, develop care plans with them, and help guide them through the healthcare system to improve the overall experience

 

Data And Technological Innovation

    • Support population health development of behavioral health data models - offering both clinical and design support based on knowledge of behavioral health.
    • Craft innovative behavioral health programs and interventions to increase access to care and improve clinical outcomes
    • Scope and drive analysis for build/buy/partner strategy around non-traditional mental healthcare modalities, i.e. telemental health, cCBT, mental health apps, etc.
    • Craft optimal end to end member behavioral health journey and collaborate with Product and Engineering to implement

 

Managed Behavioral Health Vendor (MBHO) Management

    • In conjunction with population health, develop hypotheses and analyze behavioral health vendor data to determine opportunities for clinical and/or operational intervention, mitigation of fraud, waste and abuse and improvement of overall vendor performance.
    • Support oversight of federal and state required behavioral health reporting, including timely submission and quality assessments.

 

About You

  • Formal Behavioral Health background (Nurse Practitioner, PhD, PsyD, etc) with 3+ years of experience
  • Excited about helping others, and Oscar, improve
  • Passionate about changing the healthcare experience for our members and improving their health
  • Respond to challenges with patience, empathy, and tenacity while maintaining a flexible attitude
  • Have intermediate or advanced computer literacy skills
  • Enjoy working in a diverse, collaborative environment
    • Active, unrestricted license and are able to obtain additional state licenses as needed.

 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

Pay Transparency Policy: Oscar's Pay Transparency Policy ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

Company Description

Health care is broken; we're trying to fix it. The Oscar team is focused on utilizing technology, design and data to humanize health care. We're a group of technology and health care professionals who looked at the current state of the US health care system, got frustrated by the horrible consumer experience, and decided to do something big about it. Backed by a renowned set of investors and advisors, we’ve set out to revolutionize health care.

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