Program Director Behavioral Health
Cambia Health Solutions

Job Info

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Program Director Behavioral Health
Portland, OR; Seattle, WA; Burlington, WA; Lewiston, ID; Boise, ID; Salt Lake City, UT; Tacoma, WA; Medford, OR; Salem, OR; Telecommute.

The Program Director Behavioral Health provides leadership and clinical direction for behavioral health services across all health plan lines of business. This position partners 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. The Program Director Behavioral Health integrates with 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. This role serves as company-wide Behavioral Health subject matter expert and manages the behavioral health strategy and related initiatives to ensure work stays on track, quality results are achieved and the program continually evolves to become a comprehensive, best-in-class program.

Responsibilities

• 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.
• Collaborates with Medical Directors, Health Informatics, Provider Services and other departments as needed to collect, analyze and report on effectiveness of programs and address quality of care issues.
• Aligns behavioral health program strategy and goals with organization's vision and strategy.
• Champions and creates a sense of urgency within the organization related to evolving behavioral health programs.
• Partners with business operations units, information technology staff, Health Care Services Teams and others to lead organizational change.
• Trains the organization on all program related changes as necessary and drives communication strategy across functional teams and the organization.
• Works closely with cross-functional leaders to clarify program goals and create operational plans to ensure successful execution of the relationship with our provider partners.
• Develops and oversees monitoring and reporting procedures to ensure deliverables and budget are on track.
• Communicates program status and areas of risk or opportunity.

Minimum Requirements

• Demonstrated behavioral health competency through direct behavioral health experience such as providing behavioral health care directly to patients, working with behavioral health providers and experience with behavioral health plans and vendors.
• Experience planning, designing, implementing and managing programs, including the development of short-term and long-term goals.
• Expertise regarding Behavioral Health programs with a focus on population health and care coordination.
• Proven ability to build relationships and deliver results within a matrix organization, collaborating with diverse business partners and stakeholders who may or may not have direct accountability or engagement.
• Excellent judgment, problem solving, creativity, flexibility, analytical, communication and presentation skills.
• Strong facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse stakeholders.
• Knowledge of current industry trends and behavioral health innovations, provider reimbursement strategies and integrated care management models.
• Extensive knowledge and demonstrated ability to create, manage and lead in a quality driven organization, ensuring compliance with all local, state and federal regulatory requirements, including HEDIS.
• NCQA or URAC Accreditation experience strongly preferred.
• Strong business acumen including understanding market dynamics, financial/budget management, data analysis and decision making.
• Experience in areas such as care management models, partnerships with providers, third-party suppliers of clinical services, community groups and other member-touching stakeholders.
• Proven ability to lead the design, development and implementation of process, structure, tools and measurement indicators that drive operational results.

Normally to be proficient in the competencies listed above

Program Director, Behavioral Health would have a Master's Degree in psychology, sociology, social work or a related field, 10 years behavioral health clinical experience and 5 years of management experience in health insurance or managed care related to behavioral health or an equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

• Active unrestricted professional license in nursing, psychology, psychiatry, social work or a related clinical field.

FTEs Supervised

• 2-3 direct, 10 - 20 indirect

Work Environment

• Work primarily performed in office environment or remotely. If remote, travel will be required to our main offices and attend some customer meetings within OR, WA, UT, or ID.

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.

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