Sr. Director, Behavioral Health

Your Role

Blue Shield of California is looking for a clinical leader to oversee the behavioral health program for all product lines. The Sr. Director of Behavioral Health will report to the VP, Medical Care Solutions. This individual will be the subject matter expert and leader for utilization management and case management behavioral health delivering on all aspects of Behavioral Health- Utilization Management (UM) and Case Management (CM).  This Sr. Director will also provide direction and leadership in compliance with regulatory requirements on key operational metrics.

Your Work

In this role, you will:

• Be accountable for behavioral health annual strategic planning, resource planning to ensure appropriate resources are allocated to projects and are appropriately calculated for utilization management and care management in the department budget.
• Acts as a change agent to improve behavioral health performance results, provides organizational effectiveness leadership to achieve department goals (people/process/technology).
• Be responsible for the utilization management and case management teams that focus on accurate processing of service requests, timely processing of services requests, high quality patient care, and other high member touch programs.
• Establish strong partnerships across the organization including Human Resources, Planning & Finance, Provider Network, Claims, Compliance, Quality Improvement, Program Delivery (Project Management Office) and IT.
• Collaboratively work across multiple business areas to obtain agreement from all impacted parties when addressing cross functional organizational problems.
• Coordinate utilization management and care management team readiness for new benefits implementations with the goal of ensuring all members have access to the right care, at the right time, and at the right benefit at the right price on their effective date and all operational metrics are within agreed upon service levels.
• Develop and maintain a training and learning development plan. 
• Ensure ongoing business process management using continuous process improvement practices, and implementation of technology to drive greater efficiency, productivity and customer experience.            
• Ensure a culture of affordability, drives leadership principles among people managers, and ensures team actions are in place to make Blue Shield a great place to work.
• Ensure teams are having daily to weekly team meetings and reviewing operational metrics and department goals.
• Ensure front line staff are receiving weekly to monthly one on one coaching celebrating successes and discussing opportunities for improvement.         
  
   

Your Knowledge and Experience

• Current CA RN License. LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences. 
• Requires a college degree or equivalent experience and minimum 12 years prior relevant experience, including 6 years of management experience. 
• Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.
• Knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, CMS, DHCS).
• Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirables.
• Requires broad management knowledge to lead project teams in one department/function or large centralized function.
• Master’s Degree in a healthcare field preferred.