Sr. Director, Behavioral Health

Job Description

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.

Responsibilities

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.

Qualifications

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.

Pay Range:

The pay range for this role is: $ 198000.00 to $ 297110.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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About the Team

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
  
  • Member-facing and approved out-of-state roles remain remote.
  • Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
  • For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.