Anthony M. Van Jones, LCSW, ACSW

Experience

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  United Behavioral Health

  Feb 1995 - Jan 2002

  Project Director, Public Sector Medicaid

  Responsible for day to day operations of the United Behavioral Health-King County public sector Medicaid contract, providing care management, network development, quality oversight, UR and financial modeling for County payer •Supervised CFO, COO, CCO, and Member Services, Information Systems, and Quality Management departments. •Liaison between County-payer, Corporate and Provider network. •Facilitated and coordinated the core business functions across UBH Seattle business units to ensure the highest level of Provider customer service.Director of Provider Relations and Clinical Services Responsible for the development of contracts and oversight of the King County’s Medicaid Mental Health Plan Provider Network. •Supervised Contracts Administrators, and conducted contract negotiations with current and potential providers to ensure a responsive, culturally appropriate network.•Maintained the provider network, including the recruitment, contracting and credentialing of core and specialty providers. Show less

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  University of Washinton

  Jan 2002 - Jul 2005

  Harborview ED-CTU

  Conducted full psychiatric evaluations, psychosocial assessments and discharge planning for medical, psychiatric and chemically involved youth, adult and older adults’ in an urban Level I Trauma Emergency Department. • Conducted bio-psychosocial evaluations on the ED Crisis Triage Unit.• Medical social worker on Level 1 Trauma ED unit.• Utilization review on inpatient psychiatry unit.

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  Long Island College Hospital

  Oct 2005 - Jun 2007

  Director of Outpatient Mental Health Services, Department of Psychiatry

  Responsible for the oversight of a large hospital-based Outpatient and Partial Hospitalization program within the Department of Psychiatry serving a predominantly Medicaid population. •Responsible for the day to day operation of all outpatient programs;•Provided Clinical Leadership, Quality Management, Budget, Billing, Personnel, Utilization Review, Regulatory compliance; including County, State, and Federal Medicare and Medicaid policies.

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  Magellan Health Services

  Jun 2007 - Aug 2009

  National Director of Business Development, Public Sector Solutions

  Responsible for the development of, and response to public sector behavioral health MCO Medicaid business opportunities nationally. •Assessed potential opportunities in states and communities looking to develop or redesign managed behavioral health care; Medicaid, HP, -Medicaid, Government) programs through a competitive procurement process. •Developed effective winning working relationships with stakeholders including state officials, consumers, advocates and providers. •Systems and clinical subject matter expert on each project, •Successfully managed the development of RFP responses as well as final coordination and production of all proposals. Show less

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  Phoenix House

  May 2010 - Jul 2012

  Director Managed Care and Regional Clinical Director

  Successfully designed and implemented the region’s managed care utilization management system, resulting in a 64% increase in the agency’s private insurance revenues between FY11 and FY12. -Hired, trained and supervised all UR staff,-Diversified funding and achieved private insurance goals-Trained facility staff on managed care principles, documentation, reporting and assessment criteria.-Responsible for managing contracts, marketing and developing metrics to effectively measure targets.New York Region Clinical Director: Responsible for the Clinical leadership and oversight of fourteen residential programs and four outpatient programs in New York State; including Quality Management, Budgeting, Billing, Personnel, Utilization Review, and regulatory compliance. Developed effective working relationships with stakeholders including, state officials, consumers, advocates and providers. Show less

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  MHN

  Aug 2012 - Sept 2013

  Clinical Supervisor HLOC

  Responsible for the successful clinical and administrative operations of the New York HLOC commercial and Medicare /Medicaid managed behavioral health care services. •Directed the day-to-day operations and staffing through the development and use of tailored performance metrics.•Ensured clinical quality and cost effectiveness by trending; utilization, outliers, productivity, auditing; and InterQual data.•Ensured compliance with HEDIS, NCQA, URAC and CMS. •Responsible for the recruitment, hiring, training and supervision of licensed and support staff. Show less

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  Beacon Health Strategies

  Sept 2013 - Nov 2014

  Senior Program Director

  Overall management of Beacon Health Strategies clinical and administrative behavioral health managed care operations for Affinity and AmidaCare Health Plans. Lines of business include Medicaid, three Medicare products, H-SNP and a Qualified Health Plan.• Oversee all operations of the program and ensure compliance with all regulatory requirements.• Direct local operations and supervise on site ICM staff and remote UM clinicians.• Responsible for ensuring accurate and timely data file exchanges. • Reporting and analysis of program utilization and case management trends, performance indicators and operational metrics.• Conduct contract oversight meetings with the account(s) and present performance data summaries. Show less

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  Centene Corporation

  Jan 2015 - now

  Managed Behavioral Health, EAP, ICM and Outpatient Oversight

  Responsible for the successful clinical operations of Outpatient, EAP, Commercial, Medicare and Medicaid managed behavioral health utilization along with Complex Care ICM and Co-Management. • Direct the day-to-day clinical operations for an Outpatient and EAP team• Manage ICM and Co-Management cases • Medicare, Medicaid, Duals