Director, Behavioral Health Care Management

Blue Shield of CA; Lodi (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

An established industry player is looking for a clinical leader to drive behavioral health care management across diverse product lines. This pivotal role involves ensuring compliance with regulatory standards while enhancing care coordination for behavioral health members. The ideal candidate will bring extensive management experience and a strong understanding of healthcare regulations. Join a forward-thinking organization dedicated to improving the lives of its members through innovative care management solutions. If you are passionate about making a difference in behavioral health, this opportunity is perfect for you.

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 key operational metrics.

Skills

Behavioral Health Management

Regulatory Compliance

Project Management

Coordination of Care

Education

Master's Degree in Healthcare

Bachelor's Degree or Equivalent Experience

Tools

URAC Standards

NCQA Standards

CMS Regulations

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 pivotal in achieving the goals of Blue Shield of California and 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 criteria for level of care and length of stay
• Broad management knowledge to lead project teams within one department or large centralized function