Senior Director, Behavioral Health Operations Oversight

4 weeks ago

Long Beach, California, United States Blue Shield Of California Full time
Job Description

Your Role

The Senior Director, Behavioral Health Operations Oversight is responsible for ensuring behavioral health program integrity and compliance with state and federal regulatory standards and accreditation standards. This position works closely with management and employees to facilitate compliance with applicable federal and state regulatory requirements.

Your Work

  • Serves as business driver for enterprise-wide behavioral health initiatives and mandate implementations.
  • Directs behavioral health projects, initiatives, executive-sponsored initiatives, responses to regulatory audits, accreditations, on-site reviews, risk assessments to support behavioral health compliance.
  • Oversees all behavioral health compliance committees for all lines of business.
  • Leads internal monitoring to identify behavioral health process gaps, validate behavioral health operational compliance levels, map processes, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations.
  • Develops strategic plans, makes recommendations to leadership; designs/implements annual clinical operations compliance plan.
  • Develops strong relationships with key leaders to identify and address regulatory risks and failures.
  • Accountable for action plans designed to fully mitigate risk(s).
  • Reviews and analyzes regulations to determine the impact on plan behavioral health operations and identifies the need for new or revised policies, procedures, plan documents.
  • Establishes an annual work plan for ongoing review of all behavioral health-related operations to ensure regulatory compliance standards are met and any issues found are corrected.
  • Designs behavioral health regulatory compliance training and materials; Reviews and develops policies and procedures from compliance perspective and maintains annual review and management of policies and procedures.
  • In collaboration with compliance and regulatory affairs teams, prepares communications and reporting with the regulatory agencies such as DMHC filing submissions, regulatory reporting, and ad-hoc requests.
  • In collaboration with compliance and regulatory affairs teams, participates in the DMHC and DHCS regulatory meetings as they pertain to behavioral health.
  • In collaboration with compliance and regulatory affairs teams, prepares routine regulatory reports and analysis to include, but not limited to, Department of Health Care Services (DHCS); Department of Managed Health Care (DMHC); the California Department of Public Health (CDPH); Centers for Medicare and Medicaid Services (CMS).

Qualifications

Your Knowledge and Experience

  • Requires a Bachelor's degree, and a minimum of 12 years prior relevant experience in a managed care healthcare setting with experience in Compliance, HIPAA/Privacy, FWA and/or Regulatory Affairs operations preferred, including 6 years of management experience.
  • Master's degree in relevant field preferred (e.g., clinical psychology or similar).
  • Certificate of Healthcare Compliance (CHC) preferred.

Our Workplace Model

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working:

  • Hybrid - In a business unit approved office a few times per week.
  • Office - In a business unit approved office 4+ days a week.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment.

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