Director, Behavioral Health, Health Plans

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
• Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals
• This position could be remote

What You Will Do

• Drives the strategic planning process for Behavioral Health (BH) services, identifying opportunities for differentiation and enhanced service delivery. Executes strategies with aim to improve member outcomes and operational efficiency. Continuously develop, implements, monitors, and assesses behavioral health programs, ensuring they align with the organization's strategic vision and effectively meet our members' needs.
• Leads the BH clinical operations team with a strategic and growth-oriented mindset, aiming to achieve improved clinical outcomes and reduced healthcare costs. Identifies appropriate interventions aligned with the designated model of care while also continuously seeking innovative approaches and solutions. Fosters a culture of strategic thinking and growth, encourage the team to embrace change, adapt to evolving healthcare landscapes, and consistently pursue excellence in patient care.
• Develops and revises behavioral health protocols and guidelines to ensure compliance with state requirements and medical necessity criteria.
• Designs and implements clinical services that are member-centric, utilizing a comprehensive approach incorporating behavioral health, social care, physical health and pharmacologic data.
• Leads the development, implementation, and interpretation of clinical-medical policies specific to behavioral health or other policies which can be expected to impact the health and recovery of our members .
• Fosters collaboration and coordination between physical health and behavioral health care to enhance integrated member care. Aims to deliver more comprehensive care, improve health outcomes, reduce the stigma associated with mental health, and ensure both physical and behavioral needs are addressed in a cohesive and efficient manner.
• Engages in and contributes to the interdisciplinary team's utilization management activities and recommended interventions for members/participants. Establish procedures to record the outcomes of rounds meetings and ensure the prompt execution of decisions and effective communication back to the team.
• Participates in the development and implementation of the behavioral health sections of the Quality Management (QM)/Utilization Management (UM) Plan. Oversees the administration of all BH QM/UM and performance improvement activities, encompassing grievances and appeals, and contributes to various other subcommittees such as Compliance and Pharmacy.
• Develops, implements, monitors and evaluates Utilization and Care Management metrics specific to Behavioral health services across all plan types as necessary. This process includes the formulation of specific objectives and key results (OKRs) to ensure targeted and measurable outcomes in service delivery.
• Oversees and ensures timely completion of all required assessments and plans of care for members, ensuring they are conducted within appropriate timeframes by the right staff. This includes monitoring staff performance through regular audits and other evaluative measures to maintain high-quality care standards.
• Plans leadership and medical director meetings as stipulated by the State BH contract manager. Serves as the principal behavioral health/social care expert and liaison for all relevant governmental agencies, as required. Acts as the key intermediary between the health plan and the State, addressing issues related to BH compliance, regulatory and program improvements, requirements, and other related matters.
• Oversees the integrity, upgrades, customization and reporting capabilities of multiple systems, with a specific focus on incorporating behavioral health input. Ensures systems are properly configured to facilitate effective reporting and monitoring, thereby enhancing departmental efficiencies and ensuring regulatory compliance.
• Acts as liaison for new projects and leads process improvement initiatives aimed at achieving operational goals and return on investment (ROI).
• Engages in advocacy groups to champion the quality of behavioral health and social care in the MCO population. Collaborates with other Plan staff in liaising with social, governmental, health and community agencies to identify and shape public policy issues relevant to the Program. Additionally, stays informed about local trends and regional issues to maintain a current and comprehensive understanding of the community's needs.
• Oversees the implementation and monitoring of utilization review and quality management procedures, while also conducting specialized studies and audits as necessary. Identifies areas for improvement and implements recommended enhancements to ensure optimal efficiency and effectiveness.
• Assist in the development and implementation of training programs for staff and network providers. Ensure training programs are comprehensive, up-to-date, and aligned with the latest industry practices and state regulations.
• Ensures that staff are proficient in delivering care to members with behavioral health and social care needs staying current with the latest clinical information, practices, and technology through comprehensive orientation and ongoing education. Oversees clinical peer review, and manages the recruitment, education, training, and orientation of providers.
• Develops and enhances the coordination and positive relationships with community providers, related programs, regions, the family of corporations, clients, and contractors. Ensures representation at key meetings, either through personal attendance or delegation, and collaborates effectively to serves as a liaison for the plan. Promotes a positive image of the plan by fostering collaborative working relationships with other providers.
• Performs all other duties inherent in a senior managerial role. Approves staff training, hiring, promotions, terminations, and salary actions and evaluates staff performance for direct reports. Prepares and ensures adherence to department budget
• Participates in special projects and performs other duties as assigned.

Work Experience

• Minimum of eight years' experience in behavioral health or social work required within a behavioral health organization (BHO), with minimum of 4 years in a BH utilization and care management Director or above leadership role within a managed care organization required
• Proven experience in developing and implementing Behavioral Health-specific protocols, including policies, procedures, and NYS level of care guidelines that comply with state-level care requirements and medical necessity criteria required
• Demonstrated leadership experience in BH utilization and care management, particularly for members with Severe Mental Illness (SMI), Substance Use Disorders (SUD), co-occurring physical health issues, and dual disorders of mental health and substance abuse. required
• Experience developing, implementing, delivering, and overseeing comprehensive training programs for both internal staff and network providers in Behavioral Health, aligned with the latest industry standards, regulatory requirements, and best practices in behavioral health care. required
• Experience in envisioning and executing long-term strategies for behavioral health care and service improvement. required
• A track record of strategic thinking and the ability to create differentiated services in the behavioral health field. preferred
• Excellent oral/written/interpersonal communication skills required

Education

• Master's Degree in Social Work required

Licenses and Certifications

• License and current registration to practice as a Licensed Clinical social worker (LCSW) in New York State or other independent licensure (LMHC, LMFT, clinical psychologist, or psychiatric Nurse Practitioner). required
• Licensure in other states is an additional benefit. preferred