Sr. Director, Behavioral Health Operations and Oversight

Job Description

Your Role

The Senior Director, Behavioral Health Operations Oversight ensures 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.

Responsibilities

Your Work

In this role, you will:

• Serve as business driver for enterprise-wide behavioral health mandate implementations
• Direct behavioral health projects, initiatives, executive-sponsored initiatives, responses to regulatory audits, accreditations, on-site reviews, risk assessments to support behavioral health compliance
• Oversee all behavioral health compliance committees for all lines of business
• Lead 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
• Develop strategic plans, makes recommendations to leadership; designs/implements annual clinical operations compliance plan
• Develop strong relationships with key leaders to identify and address regulatory risks and failures. Accountable for action plans designed to fully mitigate risk(s)
• Review and analyzes regulations to determine the impact on plan behavioral health operations and identifies the need for new or revised policies, procedures, plan documents.
• Design 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, 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); California Department of Insurance (CDI) 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. Emphasis in behavioral health, preferred
• Requires experience in California Compliance, HIPAA/Privacy, FWA and/or Regulatory Affairs operations preferred, including 6 years of management experience
• Certificate of Healthcare Compliance (CHC) preferred
• Requires in-depth knowledge of quality and change management process
• Expert knowledge of state behavioral health regulatory requirements under the Centers for Medicare & Medicaid Services, Department of Managed Health Care and Department of Health Care Services
• Strong analytical skills, including the ability to interpret and determine the impact of complex laws, regulations, and other documents
• Knowledge of regulatory external audits, internal auditing and effective implementation, control, and monitoring processes
• Strong interpersonal skills with the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside the Health Plan
• Strong decision-making, organizational, planning, and problem-solving skills, and communication skills are needed to effectively interact with staff, team members and others in a professional and tactful manner
• Strong presentation skills with the ability to tailor presentations to a specific audience, and address and interact with large groups

About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• 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 and the Ascendiun Family of Companies, 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:

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o 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.