Sr. Director, Behavioral Health

Your Role

Blue Shield of California is looking for a clinical leader to oversee the behavioral health program for all product lines. The Sr. Director of Behavioral Health will report to the VP, Medical Care Solutions. This individual will be the subject matter expert and leader for utilization management and case management behavioral health delivering on all aspects of Behavioral Health- Utilization Management (UM) and Case Management (CM). This Sr. Director will also provide direction and leadership in compliance with regulatory requirements on key operational metrics.

Your Knowledge and Experience

• Current CA RN License. LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences.
• Requires a college degree or equivalent experience and minimum 12 years prior relevant experience, including 6 years of management experience.
• Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.
• Knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, CMS, DHCS).
• Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirables.
• Requires broad management knowledge to lead project teams in one department/function or large centralized function.
• Master's Degree in a healthcare field preferred.