- Oversight of behavioral health vendor contractual obligations, engaging operational and clinical stakeholders for performance evaluation and monitoring.
- Develop, implement, and maintain behavioral health goals, policies, short-and-long range regional strategic planning activities, including projects/services in accomplishments of established goals.
- Identify, analyze, and evaluate behavioral health data in support of development of behavioral health medical expense, clinical and quality initiatives in collaboration with external vendor(s) and stakeholders.
- Engage internal and external stakeholders to advance innovation within the behavioral health delivery system.
- Provide subject matter expertise and consultation on the development and implementation of behavioral health quality initiatives.
- Engage behavioral health providers in performance measurement and improvement activities.
- Lead the review and evaluation of new and existing behavioral health programs and services within the BH network in collaboration with external vendor(s); makes recommendations regarding contract retention, termination, changes, etc. as appropriate.
- Develop, review, and implement operational oversight of department policies and procedures and oversight documents in support of departmental operations and delegated BH vendor relationship.
- Directly supervise behavioral health team staff to ensure behavioral health objectives are accomplished consistently
- Engage in on-going performance management of staff including coaching, mentoring, development, training and succession planning to include hiring and termination decisions
- Other duties and projects as assigned by VP of Behavioral Health and/or Chief Medical Officer
- Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.
- Bachelor's Degree in healthcare related field
- Seven (7) or more years experience in a clinical or operational behavioral health role
- Minimum of five (5) years managed care organization experience with a strong working knowledge of health care operations (HMO experience preferred)
- Demonstrated leadership and experience managing direct reports
- Experience working with medicaid, commercial and dual eligible special needs plans
- Management experience in delegation oversight, health plan related regulatory requirements, inclusive of experience with Quality Improvement Process and NCQA/ HEDIS
- Experience in budget analysis, contract negotiation and vendor oversight
- Comprehensive knowledge of behavioral health networks, reimbursement structures, and provider/ hospital reimbursement mechanisms
- Strong leadership program management, analytical, planning, and goal-setting skills, including process improvement and change management.
- Excellent communication and interpersonal skills, to include the ability to negotiate and resolve conflicts and build teams
- Ability to operate in high-pressure situations
- Excellent organization/prioritization skills
- Ability to create effective relationships, influence, and collaborate at all levels within the organization
- Must exhibit a high level of professionalism and integrity
- Operate comfortably and effectively in ambiguity
- Proficient in all Microsoft applications
- Medicare experience
- Masters Degree in Business or Health care
- Licensed Behavioral Health Clinician
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Director of Behavioral Health - Smithfield, United States - Neighborhood Health Plan of RI
Description
Job Details Job Location Smithfield, RI - Smithfield, RI Position Type Full Time Education Level Bachelors Degree Travel Percentage Occasional Job Shift Daytime Job Category Management Description The Director of Behavioral Health builds and executes behavioral health clinical programming to benefit Neighborhood members. The Director requires an in-depth understanding of health plan operations, behavioral health primary care integration and the behavioral health delivery system to advance innovation and improve overall member health. This position will collaborate closely with internal and external stakeholders providing subject matter expertise to quality improvement initiatives, population health initiatives, and value-based payment programs.Duties and Responsibilities:
Responsibilities include, but are not limited to the following:
Qualifications:
Required
Preferred:
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
