Director of Behavioral Health Program Management
2 weeks ago
Blue Shield of California is seeking a seasoned leader to oversee the behavioral health program for all product lines. As the Director of Case Management (Behavioral Health), you will report to the Senior Director of Care Management and be responsible for leading the utilization management and case management teams.
Your Work- Develop and implement strategic plans to ensure the effective allocation of resources and achievement of department goals.
- Act as a change agent to improve behavioral health performance results and provide organizational effectiveness leadership to achieve department goals.
- Lead the utilization management and case management teams in providing high-quality patient care and ensuring accurate and timely processing of service requests.
- Establish strong partnerships across the organization to drive business results and improve member experience.
- Collaborate with multiple business areas to address cross-functional organizational problems and ensure seamless implementation of new benefits.
- Develop and maintain a training and learning development plan to enhance team capabilities.
- Ensure ongoing business process management using continuous process improvement practices and implementation of technology to drive greater efficiency and productivity.
- Foster a culture of affordability and drive leadership principles among people managers to make Blue Shield a great place to work.
We are looking for a candidate with a current CA RN License and LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences. Advanced degree preferred commensurate with field. Master's Degree preferred in a healthcare field. Certified Case Manager (CCM) or in process of completing certification when eligible based on CCM application requirements or National Certification in related field.
Requires at least 10 years of prior relevant experience (UM, CM, BH). Utilization Management, Case Management, and Behavioral Health experience at a health plan preferred. Requires a minimum of 10 years combined experience managing projects, programs, complex changes initiatives, and/or CMS, NCQA, DHCS audits and regulatory compliance. Requires a minimum of 10 years' experience in developing and executing strategic business plans and budgets with a track record of achieving results. A minimum of 6 years of experience successfully managing people and leading teams. Requires strong knowledge of CMS and MediCal regulation rating systems (i.e., NCQA, Stars, QRS).
Pay Range: The pay range for this role is: $165,990.00 to $248,930.00 for California.
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