Director, Behavioral HealthOregon, Washington, Utah, Idaho or Remote
The Director of Behavioral Health provides enterprise-wide leadership and clinical direction for behavioral health services across all health plan lines of business. This role has three core responsibilities: oversee the behavioral health clinical operations including utilization management and case management; lead the development and execution of an enterprise-wide behavioral health strategy including chairing the Behavioral Health Leadership Council; representing the behavioral health program to external parties and customers including contribution to RFPs, finalist presentations, and ad hoc information and education requests.
Behavioral Health Clinical Operations: The Director work in partnership with Medical Director and Clinical Services Leadership to ensure behavioral health clinical programs are compliant with regulatory and accrediting standards and are designed to manage health care costs while achieving quality outcomes. Provides consultation to a variety of teams such as Product, Network Management, and Sales to ensure behavioral health offerings are market competitive, we maintain a strong behavioral health provider network, and we grow membership. Leads selection of behavioral health solutions and vendors, working collaboratively with ECHO and Journi partners for shared opportunities.
Behavioral Health Strategy: Serves as company-wide Behavioral Health subject matter expert and leads the development of a cross-functional enterprise behavioral health strategy and related initiatives to achieve corporate and division strategic objectives. Includes facilitating and supporting the Behavioral Health Leadership Council, a cross-functional group of health plan operational leaders driving behavioral health improvement initiatives in their respective operational areas.
Behavioral Health Sales Support: Serves as the behavioral health consultant and program representative with customers and other external entities including representing the behavioral health program in RFPs and finalist meetings and responding to requests from customers for behavioral health information; and adapting the behavioral health program to respond to customer needs.
* Partners with the Medical Director, Behavioral Health to create a competitive industry leading behavioral health strategy that is integrated with clinical services, pharmacy and provider network teams.
* Implements and leads an integrated behavioral health program and provides ongoing evaluation to ensure we are providing the best support to our members with behavioral health needs and are market competitiveness.
* Prepares and presents behavioral health strategies, program summaries, and outcomes to various committees and all levels of stakeholders and executive leadership. Represents program goals and initiatives with various audiences.
* Makes recommendations regarding use of vendors to support organizational behavioral health strategy.
* Provides clinical expertise and leadership to improve the quality and cost of care delivered to members through provider partnerships.
* Represents the organization in external forums and in support of sales, account management, and network management on topics related to behavioral health.
* In collaboration with Medical Director, Behavioral Health and medical policy team, ensures development, maintenance, application, and review of behavioral health medical necessity criteria and related policies (with final approval of the Medical Director Workgroup).
* Oversees response and ensures timeliness of response to OIC complaints regarding behavioral health through the Legislative Affairs and Correspondence Departments.