Senior Behavioral Health Program Manager, SHP

Blue Shield of North Carolina•Durham, NC

4d•Hybrid

About The Position

The Senior Behavioral Health Program Manager, State Health Plan (SHP), owns the SHP Behavioral Health (BH) program portfolio, including BH Utilization Management, Case Management, Care Navigation, and the autism spectrum disorder (ASD) and Applied Behavior Analysis (ABA) program. The role brings these areas together into a member-centered model and translates SHP contractual commitments into sustainable operations and governance. The manager partners across clinical, enterprise, compliance, network, and vendor teams to improve access, maintain alignment with the Mental Health Parity and Addiction Equity Act (MHPAEA), and deliver measurable clinical, member-experience, and affordability outcomes. The position leads program governance, implementation, process improvement, and change management through matrix teams. It supports integrated ABA utilization management and case management, navigation and closed-loop referrals, parity and compliance work, vendor and provider partnerships, audit readiness, and measurement of clinical, service, and financial performance. The role represents BCBSNC with SHP stakeholders and works with the SHP Senior Business Operations Advisor and analytics teams.

Requirements

Bachelor's degree or advanced degree where required; in lieu of a degree, 7+ years of experience in a related field.
5+ years of experience in a related field.

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, with the ability to translate 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 BH experience, and/or PMP certification.

Responsibilities

Own the SHP BH portfolio and its multi-year roadmap, aligned to SHP contractual commitments and BCBSNC strategy.
Lead governance, RAID management, and leadership reporting.
Maintain SHP-specific BH policies and workflows across UM, CM, Navigation, Appeals, Claims, and Customer Service.
Lead implementation, process improvement, and change management through matrix teams.
Support the integrated ABA UM and CM model with BH clinical leaders and ABA staff, and monitor ABA utilization, spend, and outcomes.
Support BH navigation processes with closed-loop referrals across digital partners, Customer Service, and Care Management.
Partner with Compliance, Legal, and enterprise MHPAEA experts on parity and NQTL analyses, including the BH 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 BH vendors and delegated entities through KPI monitoring, operating reviews, and corrective action, and maintain clear escalation paths for issue resolution.
Define and track BH metrics for access, utilization, authorization timeliness, ABA outcomes, member experience, and cost of care with the SHP Senior Business Operations Advisor and analytics teams.