Neighborhood Health Plan of Rhode Island Hiring For Director Of Behavioral Health at Smithfield, RI, United States Full Time

Job Description

The Director of Behavioral Health is primarily responsible for the oversite of the day-to-day operations of the Behavioral Health Department. The position includes the oversight both in-house and delegated clinical and health plan business operations including but not limited to; proper administration of behavioral health benefits, claims, utilization management, care management, member services, provider relations, access to care, regulatory compliance, reporting, budgeting and contract negotiations. The position requires skill in delineating performance measures and performance monitoring and corrective actions. The position is required to interface and maintain a positive working relationship with state agencies, community and facility based providers and other key individuals and organizations. The position has oversight responsibility of several direct reports and must be experienced in employee performance monitoring and corrective action, as well as goal setting at the corporate, departmental and individual level.
Duties and Responsibilities:
Responsibilities include, but are not limited to the following:

• Oversees the behavioral health vendor contractual obligations, including vendors compliance with purchasing specifications and performance standards, in conjunction with the delegated vendor duties and responsibilities.
• Develops, implements, and maintains behavioral health goals, policies, shortand-long range regional strategic planning activities, including projects/services in accomplishments of established goals.
• Identifies, analyzes, and evaluates behavioral health data in support of development of behavioral health medical expense budget and BH vendor utilization goals.
• Leads the review and evaluation of new and existing behavioral health programs and services within the BH network; makes recommendations regarding contract retention, termination, changes, etc. as appropriate.
• Develops, reviews, and implements operational oversight of department policies and procedures and oversight documents in support of departmental operations and delegated BH vendor relationship.
• Directly supervise behavioral health team staff to ensure the objectives of the behavioral health department are accomplished consistently
• Other duties and projects as assigned by VP of Behavioral Health and/or Chief Medical Officer
• Corporate Compliance Responsibility – As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

Qualifications:
Required

• Bachelors Degree
• Seven (7) or more years health care experience in health plan operations (HMO preferred)
• Demonstrated leadership and experience managing direct reports
• Experience working with Medicaid and Commercial Products
• Management experience in delegation oversight, health plan related regulatory requirements, inclusive of experience with Quality Improvement Process and NCQA/ HEDIS
• Experience in budget analysis, contract negotiation and vendor oversight
• Comprehensive knowledge of behavioral health networks, reimbursement structures, and provider/ hospital reimbursement mechanisms
• Ability to build and maintain strong relationships/partnerships, both internally and externally
• Effective verbal and writing skills

Preferred:

• Medicare experience
• Masters Degree in Business or Health care
• Licensed Behavioral Health Clinician