Director, Behavioral Health Care Management

Blue Shield of CA; Sacramento (CA); On-site; USD 90,000 - 150,000; Full time

Job summary

An established industry player is seeking a clinical leader to enhance behavioral health care management. In this pivotal role, you will guide a dedicated team, ensuring compliance with regulatory standards while achieving operational excellence. Your expertise in behavioral health and leadership will drive comprehensive care coordination across various product lines. Join a forward-thinking organization that values innovation and collaboration, making a significant impact on the lives of members. If you are passionate about improving healthcare outcomes and possess the leadership skills to inspire change, this opportunity is perfect for you.

Qualifications

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

Responsibilities

• Oversee behavioral health care management across all product lines.
• Collaborate with Care Management team for comprehensive care coordination.

Skills

Behavioral Health Management

Regulatory Compliance

Leadership

Project Management

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 plays a vital role in the success of Blue Shield of California and the Care Management department. This individual will collaborate with the Care Management team to deliver comprehensive care management and coordination for behavioral health members across all lines of business. Additionally, they will provide strategic direction and leadership to ensure compliance with regulatory requirements and achievement of key operational metrics.

Your Knowledge and Experience

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