Senior Behavioral Health Program Manager, SHP

Blue Cross and Blue Shield of North Carolina•Durham, CA

5d•$89,174 - $142,679•Hybrid

About The Position

The Senior Behavioral Health Program Manager, State Health Plan (SHP), owns the SHP behavioral health program portfolio, including Behavioral Health Utilization Management, Case Management, Care Navigation, and the autism spectrum disorder (ASD) and Applied Behavior Analysis (ABA) program. The role integrates these areas into a single member-centered model and translates SHP contractual commitments into sustainable operations and governance. It partners across clinical, enterprise, compliance, network, and vendor teams to improve access, maintain Mental Health Parity and Addiction Equity Act (MHPAEA) alignment, and deliver measurable clinical, member-experience, and affordability outcomes. The manager leads program governance, implementation, process improvement, and change management through matrix teams; supports the integrated ABA utilization management and case management model; and supports behavioral health navigation with closed-loop referrals. The role partners on parity and non-quantitative treatment limitation analyses and leads audit readiness for applicable accreditation and regulatory requirements. It also manages vendor and delegated-entity performance and tracks behavioral health access, utilization, authorization timeliness, ABA outcomes, member experience, and cost of care. The position requires a bachelor's degree or advanced degree where required and at least five years of related experience. In lieu of a degree, seven or more years of related experience may qualify. The role’s work arrangement is either Hybrid-Flex or Remote-Flex, depending on the nature of the work and distance from the Durham headquarters; the specific arrangement and onsite expectations are discussed during the interview process.

Requirements

Bachelor's degree or advanced degree where required; in lieu of a degree, seven or more years of experience in a related field.
At least five years of experience in a related field.
Skills listed: Business Process Improvements, Implementation Management, Process Improvement Initiatives, Process Improvements, Project Management, Project Management Oversight, Project Performance Management (PM), Project Plan Development, Resource Management, and Resource Planning.

Nice To Haves

Experience leading programs in behavioral health, health plan operations, care management, or utilization management, with demonstrated ownership of ongoing program performance.
Working knowledge of ASD and ABA services, MHPAEA and NQTL concepts, NCQA standards, and North Carolina regulatory requirements.
Experience managing vendor or delegated-entity relationships, including performance and service-level oversight.
Strong skills in program governance, risk and change management, and cross-functional facilitation, including translating complex information into clear recommendations for executive, clinical, and client audiences.
Behavioral health clinical background or licensure, such as LCSW, LCMHC, LPA, BCBA, or RN with behavioral health experience, and/or PMP certification.

Responsibilities

Own the SHP behavioral health portfolio and its multi-year roadmap, aligned with SHP contractual commitments and BCBSNC strategy.
Lead governance, risk, action, issue, and decision (RAID) management, and leadership reporting.
Maintain SHP-specific behavioral health policies and workflows across Utilization Management, Case Management, Navigation, Appeals, Claims, and Customer Service.
Lead implementation, process improvement, and change management through matrix teams.
Support the integrated ABA Utilization Management and Case Management model with behavioral health clinical leaders and ABA staff; monitor ABA utilization, spend, and outcomes.
Support behavioral health navigation processes, including closed-loop referrals across digital partners, Customer Service, and Care Management.
Partner with Compliance, Legal, and enterprise MHPAEA experts on parity and non-quantitative treatment limitation analyses, including the behavioral health impact of medical/surgical designs such as tiering and gold carding.
Lead audit readiness for NCQA, NCDOI, and federal and state requirements.
Represent BCBSNC with SHP, consultants, vendors, and providers.
Manage behavioral health vendors and delegated entities through KPI monitoring, operating reviews, corrective action, and clear escalation paths.
Define and track behavioral health metrics for access, utilization, authorization timeliness, ABA outcomes, member experience, and cost of care with the SHP Senior Business Operations Advisor and analytics teams.