Your Role

Blue Shield of California is looking for a leader to oversee the behavioral health program for all product lines. The Director of Case Management (Behavioral Health) will report to the Senior Director of Care Management. In this role you will be the subject matter expert and leader for utilization management and case management behavioral health.

Your Work

In this role, you will:

• Be accountable for behavioral health annual strategic planning, resource planning to ensure appropriate resources are allocated to projects and are appropriately calculated for utilization management and care management in the department budget.
• Acts as a change agent to improve behavioral health performance results, provides organizational effectiveness leadership to achieve department goals (people/process/technology).
• Be responsible for the utilization management and case management teams that focus on accurate processing of service requests, timely processing of services requests, high quality patient care, and other high member touch programs.
• Establish strong partnerships across the organization including Human Resources, Planning & Finance, Provider Network, Claims, Compliance, Quality Improvement, Program Delivery (Project Management Office) and IT.
• Collaboratively work across multiple business areas to obtain agreement from all impacted parties when addressing cross functional organizational problems.
• Coordinate utilization management and care management team readiness for new benefits implementations with the goal of ensuring all members have access to the right care, at the right time, and at the right benefit at the right price on their effective date and all operational metrics are within agreed upon service levels.
• Develop and maintain a training and learning development plan.
• Ensure ongoing business process management using continuous process improvement practices, and implementation of technology to drive greater efficiency, productivity and customer experience.
• Ensure a culture of affordability, drives leadership principles among people managers, and ensures team actions are in place to make Blue Shield a great place to work.
• Ensure teams have daily to weekly team meetings and reviewing operational metrics and department goals.
• Ensure front line staff receive weekly to monthly one on one coaching celebrating successes and discussing opportunities for improvement.

Your Knowledge and Experience

• Current CA RN License. LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences.
• Advanced degree preferred commensurate with field.
• Master's Degree preferred in a healthcare field.
• Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.
• Requires at least 10 years of prior relevant experience (UM, CM, BH).
• Utilization Management, Case Management, and Behavioral Health experience at a health plan preferred.
• Requires a minimum of 10 years combined experience managing projects, programs, complex changes initiatives, and/or CMS, NCQA, DHCS audits and regulatory compliance.
• Requires a minimum of 10 years' experience in developing and executing strategic business plans and budgets with a track record of achieving results.
• A minimum of 6 years of experience successfully managing people and leading teams.
• Requires strong knowledge of CMS and MediCal regulation rating systems (i.e., NCQA, Stars, QRS).

Pay Range:

The pay range for this role is: $ 165990.00 to $ 248930.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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