Director BH Clinical Operations Group Programs

HCSC•Richardson, TX

8d•Hybrid

About The Position

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for directing, planning, and organizing the behavioral health clinical operations, group programs area of the behavioral health department. Specific functions include providing assistance to the executive director BH Clinical Operations in the inclusion, involvement, management, and visibility of the department, both internal and external to HCSC, in all clinical areas; providing leadership in the management of the clinical areas; representing the department to internal personnel and external key stakeholders such as providers, regulatory bodies, members and customers; directing the inclusion of behavioral health expertise throughout the enterprise in all clinical areas and external entities; and accountable for budgetary goals being met. Must be able and willing to travel. Please note this is HYBRID position and requires in-office hours 3 days a week at the respective office location.

Requirements

Licensed Masters level medical/behavioral health professional in good standing.
10 years experience in behavioral health care with at least 5 years managed behavioral health care
5 years management experience including hiring, performance review, and oversight of budget.
Experience directing the work of behavioral health care professionals in the area of medical necessity determination.
Experience applying NCQA standards, URAC requirements and state and federal health insurance regulations.
Leadership and organizational skills.
Verbal and written communications skills to include delivering presentations to committees and acting as company representative to key stakeholders including providers, regulatory bodies, etc.
PC experience to include Microsoft Office suite of applications (Word, Excel and PowerPoint) and databases.
Able and willing to travel.
Project management experience including leading projects.
Overseeing the annual budget and allocating resources for various projects and operational needs.
Translating needs and initiatives into compelling business cases.
Conducting cost-benefit analyses to justify investments and ensure ROI.

Nice To Haves

Doctorate degree

Responsibilities

Provide direction and vision (in coordination with the VP-BH and Medical Director-BH) on clinical matters with respect to Behavioral Health (BH) Group Programs and BH integration throughout the enterprise of HCSC, as well as externally to key "stakeholders" including providers (facility and professional), members, customers, brokers, professional associations, state and federal regulators, BCBS Association, etc.
Assist in strategy development (strategic planning) and implementation with respect to BH integration.
Provide clinical expertise in all areas of BH Group Program integration and operations.
Direct health care management including utilization management (UM), care management (CM) and disease management (condition management) (DM) processes.
Direct and manage the activities of Clinical Managers.
Work with the Medical Director-BH to organize and ensure appropriate psychiatric coverage for all aspects of the clinical operations including UM/CM/DM, making sure that milestones and deadlines are met.
Liaison with staff responsible for clinical operations throughout HCSC and external to HCSC.
Direct activities involving clinical education to HCSC staff (especially full service BH Department staff), members, providers, customers, and others as related to behavioral health and behavioral health integration. Education may include mental health/chemical dependency referrals, discussion of different levels of care, and various mental health/chemical dependency topics such as disease and treatment, including evidence-based treatments.
Facilitate or direct the activities of staff involved in meeting with providers/medical groups and others to educate about services and facilities available and problem solve regarding behavioral health issues.
Direct the activities of staff involved in assisting members and medical groups in locating mental health/chemical dependency treatment.
Direct the activities of staff involved in assisting providers and FSUs in resolving complicated issues related to claims or referrals.
Direct the development of written policies and procedures related to Behavioral Health Group Program, including UM Plan documents and QI activities.