Behavioral Health Director Jobs

About The Position

Requirements

• Bachelor's Degree Related Field of Study required
• 8-10+ years of healthcare administration, business administration, public health, health insurance experience required
• At least 5-7 years of experience leading cross-functional operational work, vendor oversight, program execution, or complex healthcare operations preferred
• At least 5-7 years of experience working with Behavioral Health operations, managed care vendors, claims processing, benefit implementation, regulatory requirements, and member or provider issue resolution preferred
• Proven track record of effective change management, including but not limited to agile, waterfall, and hybrid project management, navigating organizational norms and business processes across institutions.

Nice To Haves

• Master's Degree Related Field of Study preferred

Responsibilities

• Lead operational oversight of Behavioral Health vendor administration, including coordination of business processes, issue resolution, implementation support, and ongoing monitoring of key operational deliverables.
• Serve as a primary operational liaison between MGB Health Plan and designated Behavioral Health vendors, currently Optum Behavioral Health, and any other Behavioral Health service vendors designated by the Chief Operating Officer.
• Partner with Clinical Behavioral Health, Product, IT, Claims, Customer Service, Provider Relations, Compliance, and line-of-business leaders to ensure vendor operations support Medicaid, Medicare Advantage, Commercial, and other applicable business requirements.
• Monitor operational compliance with federal and state regulatory requirements, contractual obligations, benefit coverage requirements, provider payment expectations, member cost-sharing rules, and related operational standards.
• Support Mental Health Parity compliance activities, including participation in the Mental Health Parity Committee, coordination of operational inputs, issue follow-up, and alignment of Behavioral Health vendor operations with parity-related requirements and action plans.
• Coordinate with IT application business owners (e.g., QNXT, Epic, etc.) and other system stakeholders to support appropriate application of business rules across internal and vendor systems.
• Support escalated member, provider, broker, and customer service issues by providing operational analysis, expected claims or benefit outcome guidance, and coordination of appropriate remediation steps.
• Identify, track, and escalate operational risks, defects, trends, and recurring issues related to Behavioral Health vendor operations, claims processing, benefit implementation, provider payment, member experience, and operational handoffs.
• Review operational outputs from delegated vendors, conduct ad hoc analysis to validate performance, identify trends or deficiencies, and oversee development, execution, and follow-through of corrective action plans, including review of claims processing adjustments to confirm accuracy, root cause, member or provider impact, and completion of remediation steps.
• Develop and maintain documentation of key Behavioral Health operational processes, decision points, issue logs, action plans, vendor commitments, and business requirements.
• Coordinate cross-functional workgroups as needed to address member, provider, broker, employer, or internal stakeholder friction points related to Behavioral Health operations.
• Support continuous improvement by identifying process gaps, recommending workflow improvements, and helping implement operational controls that improve quality, consistency, accountability, and transparency.
• Prepare and present concise updates, issue summaries, recommendations, and decision materials for executive and operational leadership.

Benefits

• flexible work options
• career growth opportunities
• competitive salaries
• comprehensive benefits