Director, Behavioral Health Care Management

Blue Shield of CA; California, Cameron Park (MO, CA); On-site; USD 80,000 - 110,000; Full time

Job summary

An established industry player is seeking a clinical leader to oversee behavioral health care management. This pivotal role involves collaboration on care management for behavioral health members, ensuring compliance with regulatory standards, and achieving operational goals. With a focus on leadership and coordination of care, the successful candidate will bring extensive experience in management and a deep understanding of healthcare regulations. This is an exciting opportunity to make a significant impact in a dynamic environment dedicated to improving health outcomes.

Qualifications

• Minimum of 10 years relevant experience, including 6 years in management.
• Current unrestricted CA License: RN, LCSW, LMFT, LPCC, or Licensed Psychologist.

Responsibilities

• Oversee behavioral health care management across all product lines.
• Ensure compliance with regulatory requirements and meet operational metrics.

Skills

Leadership in Behavioral Health

Care Management Coordination

Regulatory Compliance Knowledge

Project Management

Understanding of Medicare Regulations

Education

Master's Degree in Healthcare

Bachelor's Degree or Equivalent Experience

Job description

Your Role

Blue Shield of California is seeking a clinical leader to oversee behavioral health care management across all product lines. Reporting to the Sr. Director of Behavioral Health Clinical Operations, the Director of Behavioral Health Care Management will be instrumental in achieving the goals of the Care Management department. This role involves delivering and collaborating on care management and coordination for behavioral health members across all lines of business. The leader will also ensure compliance with regulatory requirements and meet key operational metrics.

Your Knowledge and Experience

• Current unrestricted CA License: RN, LCSW, LMFT, LPCC, or Licensed Psychologist
• College degree or equivalent experience; minimum of 10 years relevant experience, including 6 years in management
• Master's Degree in a healthcare-related field preferred
• Certified Case Manager (CCM) or in the process of certification when eligible, or national certification in a related field
• Knowledge of regulatory and accreditation standards (URAC, NCQA, DMHC, CMS, DHCS) preferred
• Understanding of Coordination of Care, Medicare regulations, prior authorization, and care level and length of stay criteria desirable
• Broad management knowledge to lead project teams within a department or large centralized function