Director, Behavioral Health Care Management

Your Role

Blue Shield of California is looking for a clinical leader to oversee the behavioral health care management for all product lines. Reporting to the Sr. Director, Behavioral Health Clinical Operations, the role of the Director, Behavioral Health Care Management is critical to the success of Blue Shield of California and the Care Management department in realizing its goals and objectives. This individual will play a key role as part of Care Management team in delivering and collaborating on all aspects of care management and care coordination for behavioral health membership for all lines of business. This leader will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.

Your Work

In this role, you will:

• Manage and monitor care management functions to ensure that the patient is getting the right care in a timely and cost effective way
• Lead development of Behavioral Health CM strategy by leveraging the use of data/analytics to inform and influence technology solutions to streamline operational efficiencies. Build a cost-benefit methodology to rationalize CM decisions performed based upon staffing costs, productivity, and projected medical cost savings
• Provide analysis and reports of significant utilization trends, patterns, and resource allocation.  Partner with physicians and BH clinicians to develop improved utilization of effective and appropriate services
• Establish and measures productivity metrics in order to support workforce planning methodology and rationalization of services required to provide care management that adapts to membership growth
• Ensure alignment of the care management strategy with clinical policy, payment integrity, and network development strategies to optimize quality and cost of care.
• Manage strategic projects and supporting operations initiatives
• Lead operational implementation of transformation changes (organizational management, process implementation, technology adoption)
• Responsible for care management teams' performance, resource management, continuous improvement, and training
• Responsible for operational audit readiness, ensuring adequate processes and internal audit measures in place and maintained quarterly
• Ensure all operational processes are meeting regulatory and accreditation requirements
• Ensure front line staff are receiving weekly to monthly one on one coaching celebrating successes and discussing opportunities for improvement
• Fosters a culture of process excellence, BSC leadership principles, and a great place to work environment
  
   

Your Knowledge and Experience

• Current unrestricted CA License: RN, LCSW, LMFT, LPCC, or Licensed Psychologist
• Requires a college degree or equivalent experience and minimum 10 years prior relevant experience, including 6 years of management experience
• Master’s Degree in a healthcare field preferred
• Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field
• Requires working knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, CMS, DHCS)
• Requires knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirable
• Requires broad management knowledge to lead project teams in one department/function or large centralized function