Associate Director-Speech Language Pathology

American Specialty Health Incorporated (ASH) is seeking an Associate Director-Speech Language Pathology to join our Health Services department.

The primary purpose of this position is to serve as a subject matter expert and clinical lead for speech language pathology from a clinical quality, clinical evidence, best practice and service delivery perspective to support ASH product development, operations, client interactions, and UM and Quality program activities. To perform and direct the activities of the Clinical Quality Evaluation Services and Audit Support for Speech Language Pathology. In this role, the Associate Director has direct responsibility for product development supporting the CHSO and Product Development Team as well direct responsibility for Medical Necessity Review and Clinical Quality Evaluation functions for Speech Language Pathology. The Associate Director will also support Provider Contracting and Communication through support of provider education and client meetings. This position works closely with Specialty Networks Operations to maintain MNR efficiencies and historic results. This position works independently with minimal supervision with clear understanding of when to escalate concerns and questions to management.

Salary Range

American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $112,500 Full-Time Annual Salary.

Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Responsibilities

• Develops, manages, evaluates, and is responsible for all activities within assigned scope of authority. Ensures accuracy and productivity achieves/exceeds Company standards.
  • Serves as subject matter expert and clinical lead for speech language pathology to support ASH product development, operations, client interactions, and UM and Quality program activities.
  • Performs CQE medical necessity review and supports ASH Committees and CPG development and implementation.
  • Directs the staff and ensures compliance with policy, accreditation, and regulatory requirements of these departments.
  • Oversees work-flow to subordinate staff.
  • Assists staff to resolve clinical issues.
  • Sets goals and objectives for the operation and staff.
  • Oversees initial and ongoing training of clinical staff.
  • Oversees audit process of clinical decision making within speech language pathology. .
  • Evaluates staffing needs making recommendations to Senior Vice President, Clinical Quality Evaluation and CHSO.
  • Recruits new staff members, as needed.
  • Evaluates staff performance, counsels and trains.
  • Initiates operational and clinical policies and procedures.
  • Reviews and approves expenses within scope of authority.
  • Primary interface with ASH internal staff and external consultants regarding speech and language pathology services administered by the company.
  • Supports customer audit and corrective action plan requirements.
  • Analyzes medical necessity review for quality and reporting purposes.
  • Participates as a member of the Specialty Health Policy Workgroup.
  • Communicates with customers on sensitive clinical issues.
  • Participates and works closely with the ARF Code workgroup facilitating appropriate ARF code development and implementation as indicated to support client audits.
  • Quality Improvement:
    • Participates on the Clinical Quality Team (CQT).
    • Support Key Processing Teams relating to clinical guidelines and clinical policy review and approval.
    • Assist staff, as appropriate, in supporting the resolution of clinical quality issues.
• Supports clinical decision making related to various operational functions of other administrative departments to ensure efficient and effective teamwork is maintained within the organizations.
  • Represents Clinical Quality Evaluation to resolve clinical issues related to speech language pathology.
  • Provides input to developing organization goals, strategies, budgets, and other long- and short-term planning matters.
  • Develops and oversees maintenance of monthly and quarterly department reports.
  • Conducts education and training seminars, as needed.
  • Serves on committees and key process teams.
  • Supports sales and client implementation.
  • Supports Performance Standards and Clinical Performance Management reports and presentations.
  • Supports Company in clinically relevant legal matters.
• • Travels, as required to meetings and participate in sales demonstrations.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Professional clinical degree from an accredited speech language pathology college or university required.
• 5 years of clinical practice experience or equivalent required.
• 5 years of peer medical necessity review or equivalent experience preferred.
• Oversight of speech language pathology staff or peer preferred.
• Specific experience to include specialty health care operations, specialty health care Quality Committee participation, medical necessity case review, quality administration case review, clinical policy development preferred.
• Proficient in MS Office with experience in conducting internet research required.
• Must meet ASH clinical credentialing criteria required.
• Subject Matter expertise for Speech Language Pathology from a clinical quality, clinical evidence, best practice and service delivery perspective.
• In depth understanding of the ICD and CPT coding structures for speech language pathology and applicable clinical documentation.
• Ability to identify trends, anticipate problems, and implement changes that improve use of time, resources, and process in order to meet quality and productivity goals.
• Ability to apply and communicate evidence-based criteria and guidelines to specific review scenarios and describe clinical rationale consistently and effectively.
• Project Management and Oversight Capabilities: assessing the scope of the project, identifying appropriate steps and milestones, effectively delegating and/or overseeing the delegation of tasks, setting goals and monitoring results, and recognizing barriers and finding solutions to ensure that all timelines are met.
• Ability to present a range of options and make specific recommendations to fully address customer’s unique needs and desired results.
• Ability to work with clients during clinical audits, communicate respectfully and with a high degree of knowledge on audit issues, and find solutions and resolution to audit issues.
• Strong leadership qualities and the capacity to supervise professional staff.
• Ability to set a standard of excellence as a role model, take specific steps to set goals, motivate staff, resolve conflicts, and acknowledge contributions; ability to work cooperatively with Leadership and staff to develop and manage staff schedules, balance workloads, and resolve conflicts in task prioritization.
• Ability to assess staff skills / knowledge and communicate training opportunities to supervisors.
• A current, unrestricted license to practice speech language pathology (while most states only require licensure in one state in the United States for medical necessity review, some states may require state specific licensure) required.
• Employees must maintain a current, unrestricted license to practice and must be in good standing with all judicial and governing bodies (as required).

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

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