Director, Behavioral Health Performance Monitoring & Improvement

Your Role

The Behavioral Health Services (BHS) team is responsible for developing the foundation for and executing a best-in-class behavioral health product for Blue Shield, including creating pricing models by line of business, and establishing a core operations infrastructure. The Behavioral Health Operations Oversight team ensures behavioral health program integrity and compliance with state and federal regulatory standards and accreditation standards. The Director of Behavioral Health, Program & Project Management with a specialization in Performance Monitoring & Improvement, will report to the Sr. Director of Behavioral Health Operations Oversight. 

In this role you will work closely with management and employees to assess, diagnose and improve behavioral health operations performance and facilitate compliance with applicable federal and state regulatory requirements. The Director of Behavioral Health, Program & Project Management will work with business owners to ensure an understanding of new and existing regulatory requirements to escalate and resolve risks identified through the assessment process, promote ongoing program integrity and compliance, and collect and review necessary documentation in support of preparing for successful surveys/audits. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In This Role, You Will:

• Serve as a senior leader of small team who is responsible for Blue Shield’s behavioral health operations performance monitoring and improvement
• Builds relationships with leaders to identify and address performance risks, ensuring mitigation through action plans
• Formulate and implement the Behavioral Health Operations Performance Monitoring program and strategy, including the new Behavioral Health Oversight Committee and mechanisms to oversee behavioral health policy, procedures, and supporting documentation including process flows, desk level procedures, and service level agreements currency and accuracy
• Develops the annual performance monitoring and improvement work plan to regularly review all behavioral health-related health oversight and operational functions, ensuring compliance with standards and addressing identified issues
• Oversee and improve the effectiveness of the new behavioral health workgroups and committees as well as communication and coordination with other committees
• Evaluate performance and operational data and work with appropriate teams to identify trends early, work with the clinical strategies teams to implement and manage
• Direct cross-departmental behavioral health process improvement projects when operational performance and root cause analysis reveals process improvement opportunities 
• Collaborate with other senior leaders on the team to design behavioral health regulatory compliance training and materials
•  Manages strategic projects, initiatives, audits, exams, reviews and risk assessments. Supports operations initiatives
• Monitors internal corrective action plans aimed at fully addressing identified risks.
• Collaborate with stakeholders to ensure required auditing, reporting, and monitoring is reported and tracked through established channels; participate in associated committees as necessary
• Establish tracking systems to manage and monitor key programmatic documentation (i.e. Policies & Procedures, Corrective Action Plans, regulatory reporting, etc.)
• Develop strong relationships with key leaders to identify and address compliance/performance risks and failures
• Responsible for committee governance for all quality committees that report into the Behavioral Health Operations Oversight Committee
• Fosters a culture of process excellence, BlueShield leadership principles and great place to work environment
• Drive engagement activities and employee development to ensure a high-performing team, while also serving as a role model. Responsible for various levels of staff

Your Knowledge and Experience

• Requires a Bachelor’s degree (industrial engineer preferred) or equivalent experience 
• Requires a minimum of 10 years prior relevant experience.
• Preferred experience in a managed care healthcare setting with an emphasis on continuous quality/process
• Requires at least 6 years of management experience
• Requires the ability to lead through influence and operating comfortably in a highly matrixed environment
• Prefers at least 5 years’ experience working with internal and external stakeholders to improve performance
• Requires experience implementing and overseeing a quality program, initiative or committee
• Requires experience using healthcare data to drive improvements
• Strong analytical skills, including the ability to determine the impact of regulation on processes
• Ability to prioritize and manage work and trade-offs against critical project timelines in a fast-paced environment
• Strategic thinker with end-to-end view who has an eye for detail, is organized, and can manage multiple programs simultaneously
• Excellent influence and engagement skills in building alignment and accountability without formal ownership or authority over talent resources
• Ability to build strong and sustainable relationships and the capability to interact within all levels of the organization
• Ability to work cooperatively and strategically in a team environment with all levels of professional, technical and administrative staff and to integrate resources on a timely and organized basis
• Acumen to handle complex situations and multiple responsibilities simultaneously with the urgency of immediate demands on the operations
• Strong communicator, PowerPoint/Storyboarding skills. Ability to present information clearly and concisely to various audiences