Director, Behavioral Health, Health Plans
Company: VNS Health
Location: New York
Posted on: May 18, 2024
Job Description:
OverviewDirects plans, evaluates, and coordinates Behavioral
Health and Social Care needs for multiple lines of business
including HIV-SNP -HCBS/HARP, MAP, MAPD, and DSNP Plans.
Demonstrates a commitment to delivering high-quality, personalized
Behavioral Health services, placing member needs and recovery goals
at the forefront of all initiatives.Compensation:$122,300.00 -
$164,000.00 AnnualWhat We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time
off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical,
Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and
dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career
advancement
- Internal mobility, generous tuition reimbursement, CEU credits,
and advancement opportunities
- Interdisciplinary network of colleagues through the VNS Health
Social Services Community of ProfessionalsWhat You Will Do
- Drives the strategic planning process for Behavioral Health
(BH) services, identifying opportunities for differentiation and
enhanced service delivery. Executes strategies with aim to improve
member outcomes and operational efficiency. Continuously develop,
implements, monitors, and assesses behavioral health programs,
ensuring they align with the organization's strategic vision and
effectively meet our members' needs.
- Leads the BH clinical operations team with a strategic and
growth-oriented mindset, aiming to achieve improved clinical
outcomes and reduced healthcare costs. Identifies appropriate
interventions aligned with the designated model of care while also
continuously seeking innovative approaches and solutions. Fosters a
culture of strategic thinking and growth, encourage the team to
embrace change, adapt to evolving healthcare landscapes, and
consistently pursue excellence in patient care.
- Develops and revises behavioral health protocols and guidelines
to ensure compliance with state requirements and medical necessity
criteria.
- Designs and implements clinical services that are
member-centric, utilizing a comprehensive approach incorporating
behavioral health, social care, physical health and pharmacologic
data.
- Leads the development, implementation, and interpretation of
clinical-medical policies specific to behavioral health or other
policies which can be expected to impact the health and recovery of
our members .
- Fosters collaboration and coordination between physical health
and behavioral health care to enhance integrated member care. Aims
to deliver more comprehensive care, improve health outcomes, reduce
the stigma associated with mental health, and ensure both physical
and behavioral needs are addressed in a cohesive and efficient
manner.
- Engages in and contributes to the interdisciplinary team's
utilization management activities and recommended interventions for
members/participants. Establish procedures to record the outcomes
of rounds meetings and ensure the prompt execution of decisions and
effective communication back to the team.
- Participates in the development and implementation of the
behavioral health sections of the Quality Management
(QM)/Utilization Management (UM) Plan. Oversees the administration
of all BH QM/UM and performance improvement activities,
encompassing grievances and appeals, and contributes to various
other subcommittees such as Compliance and Pharmacy.
- Develops, implements, monitors and evaluates Utilization and
Care Management metrics specific to Behavioral health services
across all plan types as necessary. This process includes the
formulation of specific objectives and key results (OKRs) to ensure
targeted and measurable outcomes in service delivery.
- Oversees and ensures timely completion of all required
assessments and plans of care for members, ensuring they are
conducted within appropriate timeframes by the right staff. This
includes monitoring staff performance through regular audits and
other evaluative measures to maintain high-quality care
standards.
- Plans leadership and medical director meetings as stipulated by
the State BH contract manager. Serves as the principal behavioral
health/social care expert and liaison for all relevant governmental
agencies, as required. Acts as the key intermediary between the
health plan and the State, addressing issues related to BH
compliance, regulatory and program improvements, requirements, and
other related matters.
- Oversees the integrity, upgrades, customization and reporting
capabilities of multiple systems, with a specific focus on
incorporating behavioral health input. Ensures systems are properly
configured to facilitate effective reporting and monitoring,
thereby enhancing departmental efficiencies and ensuring regulatory
compliance.
- Acts as liaison for new projects and leads process improvement
initiatives aimed at achieving operational goals and return on
investment (ROI).
- Engages in advocacy groups to champion the quality of
behavioral health and social care in the MCO population.
Collaborates with other Plan staff in liaising with social,
governmental, health and community agencies to identify and shape
public policy issues relevant to the Program. Additionally, stays
informed about local trends and regional issues to maintain a
current and comprehensive understanding of the community's
needs.
- Oversees the implementation and monitoring of utilization
review and quality management procedures, while also conducting
specialized studies and audits as necessary. Identifies areas for
improvement and implements recommended enhancements to ensure
optimal efficiency and effectiveness.
- Assist in the development and implementation of training
programs for staff and network providers. Ensure training programs
are comprehensive, up-to-date, and aligned with the latest industry
practices and state regulations.
- Ensures that staff are proficient in delivering care to members
with behavioral health and social care needs staying current with
the latest clinical information, practices, and technology through
comprehensive orientation and ongoing education. Oversees clinical
peer review, and manages the recruitment, education, training, and
orientation of providers.
- Develops and enhances the coordination and positive
relationships with community providers, related programs, regions,
the family of corporations, clients, and contractors. Ensures
representation at key meetings, either through personal attendance
or delegation, and collaborates effectively to serves as a liaison
for the plan. Promotes a positive image of the plan by fostering
collaborative working relationships with other providers.
- Performs all other duties inherent in a senior managerial role.
Approves staff training, hiring, promotions, terminations, and
salary actions and evaluates staff performance for direct reports.
Prepares and ensures adherence to department budget
- Participates in special projects and performs other duties as
assigned.QualificationsWork Experience
- Minimum of eight years' experience in behavioral health or
social work required within a behavioral health organization (BHO),
with minimum of 4 years in a BH utilization and care management
Director or above leadership role within a managed care
organization required
- Proven experience in developing and implementing Behavioral
Health-specific protocols, including policies, procedures, and NYS
level of care guidelines that comply with state-level care
requirements and medical necessity criteria required
- Demonstrated leadership experience in BH utilization and care
management, particularly for members with Severe Mental Illness
(SMI), Substance Use Disorders (SUD), co-occurring physical health
issues, and dual disorders of mental health and substance abuse.
required
- Experience developing, implementing, delivering, and overseeing
comprehensive training programs for both internal staff and network
providers in Behavioral Health, aligned with the latest industry
standards, regulatory requirements, and best practices in
behavioral health care. required
- Experience in envisioning and executing long-term strategies
for behavioral health care and service improvement. required
- A track record of strategic thinking and the ability to create
differentiated services in the behavioral health field.
preferred
- Excellent oral/written/interpersonal communication skills
requiredEducation
- Master's Degree in Social Work requiredLicenses and
Certifications
- License and current registration to practice as a Licensed
Clinical social worker (LCSW) in New York State or other
independent licensure (LMHC, LMFT, clinical psychologist, or
psychiatric Nurse Practitioner). required
- Licensure in other states is an additional benefit.
preferred
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Keywords: VNS Health, Clifton , Director, Behavioral Health, Health Plans, Accounting, Auditing , New York, New Jersey
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