Director of Behavioral Health Services
2 days ago
We are seeking a highly experienced and skilled Director of Behavioral Health to lead our Behavioral Health team at VNS Health. As a key member of our leadership team, you will be responsible for driving the strategic planning process for Behavioral Health services, identifying opportunities for differentiation and enhanced service delivery.
Key Responsibilities- Develop and implement Behavioral Health-specific protocols, including policies, procedures, and NYS level of care guidelines that comply with state-level care requirements and medical necessity criteria.
- Lead the Behavioral Health clinical operations team with a strategic and growth-oriented mindset, aiming to achieve improved clinical outcomes and reduced healthcare costs.
- Foster a culture of strategic thinking and growth, encourage the team to embrace change, adapt to evolving healthcare landscapes, and consistently pursue excellence in patient care.
- Develop and revise behavioral health protocols and guidelines to ensure compliance with state requirements and medical necessity criteria.
- Design and implement clinical services that are member-centric, utilizing a comprehensive approach incorporating behavioral health, social care, physical health, and pharmacologic data.
- Lead the development, implementation, and interpretation of clinical-medical policies specific to behavioral health or other policies which can be expected to impact the health and recovery of our members.
- Foster collaboration and coordination between physical health and behavioral health care to enhance integrated member care.
- Engage in and contribute to the interdisciplinary team's utilization management activities and recommended interventions for members/participants.
- Participate in the development and implementation of the behavioral health sections of the Quality Management (QM)/Utilization Management (UM) Plan.
- Oversee the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals, and contribute to various other subcommittees such as Compliance and Pharmacy.
- Develop, implement, monitor, and evaluate Utilization and Care Management metrics specific to Behavioral health services across all plan types as necessary.
- Oversee and ensure timely completion of all required assessments and plans of care for members, ensuring they are conducted within appropriate timeframes by the right staff.
- Plan leadership and medical director meetings as stipulated by the State BH contract manager.
- Serve as the principal behavioral health/social care expert and liaison for all relevant governmental agencies, as required.
- Act as the key intermediary between the health plan and the State, addressing issues related to BH compliance, regulatory and program improvements, requirements, and other related matters.
- Oversee the integrity, upgrades, customization, and reporting capabilities of multiple systems, with a specific focus on incorporating behavioral health input.
- Ensure systems are properly configured to facilitate effective reporting and monitoring, thereby enhancing departmental efficiencies and ensuring regulatory compliance.
- Act as liaison for new projects and lead process improvement initiatives aimed at achieving operational goals and return on investment (ROI).
- Engage in advocacy groups to champion the quality of behavioral health and social care in the MCO population.
- Collaborate with other Plan staff in liaising with social, governmental, health, and community agencies to identify and shape public policy issues relevant to the Program.
- Oversee the implementation and monitoring of utilization review and quality management procedures, while also conducting specialized studies and audits as necessary.
- Identify areas for improvement and implement recommended enhancements to ensure optimal efficiency and effectiveness.
- Assist in the development and implementation of training programs for staff and network providers.
- Ensure training programs are comprehensive, up-to-date, and aligned with the latest industry practices and state regulations.
- Oversee clinical peer review, and manage the recruitment, education, training, and orientation of providers.
- Develop and enhance the coordination and positive relationships with community providers, related programs, regions, the family of corporations, clients, and contractors.
- Ensure representation at key meetings, either through personal attendance or delegation, and collaborate effectively to serve as a liaison for the plan.
- Promote a positive image of the plan by fostering collaborative working relationships with other providers.
- Minimum of eight years' experience in behavioral health or social work required within a behavioral health organization (BHO), with minimum of 4 years in a BH utilization and care management Director or above leadership role within a managed care organization required.
- Proven experience in developing and implementing Behavioral Health-specific protocols, including policies, procedures, and NYS level of care guidelines that comply with state-level care requirements and medical necessity criteria required.
- Demonstrated leadership experience in BH utilization and care management, particularly for members with Severe Mental Illness (SMI), Substance Use Disorders (SUD), co-occurring physical health issues, and dual disorders of mental health and substance abuse required.
- Experience developing, implementing, delivering, and overseeing comprehensive training programs for both internal staff and network providers in Behavioral Health, aligned with the latest industry standards, regulatory requirements, and best practices in behavioral health care required.
- Experience in envisioning and executing long-term strategies for behavioral health care and service improvement required.
- A track record of strategic thinking and the ability to create differentiated services in the behavioral health field preferred.
- Excellent oral/written/interpersonal communication skills required.
- Master's Degree in Social Work required.
- License and current registration to practice as a Licensed Clinical social worker (LCSW) in New York State or other independent licensure (LMHC, LMFT, clinical psychologist, or psychiatric Nurse Practitioner) required.
- Licensure in other states is an additional benefit preferred.
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