Job DescriptionYour Role Blue Shield of California is looking for a leader to oversee the behavioral health program for all product lines. The Director of Case Management (Behavioral Health) will report to the Senior Director of Care Management. In this role you will be the subject matter expert and leader for utilization management and case management behavioral health. Your Work In this role, you will:
- Be accountable for behavioral health annual strategic planning, resource planning to ensure appropriate resources are allocated to projects and are appropriately calculated for utilization management and care management in the department budget.
- Acts as a change agent to improve behavioral health performance results, provides organizational effectiveness leadership to achieve department goals (people/process/technology).
- Be responsible for the utilization management and case management teams that focus on accurate processing of service requests, timely processing of services requests, high quality patient care, and other high member touch programs.
- Establish strong partnerships across the organization including Human Resources, Planning & Finance, Provider Network, Claims, Compliance, Quality Improvement, Program Delivery (Project Management Office) and IT.
- Collaboratively work across multiple business areas to obtain agreement from all impacted parties when addressing cross functional organizational problems.
- Coordinate utilization management and care management team readiness for new benefits implementations with the goal of ensuring all members have access to the right care, at the right time, and at the right benefit at the right price on their effective date and all operational metrics are within agreed upon service levels.
- Develop and maintain a training and learning development plan.
- Ensure ongoing business process management using continuous process improvement practices, and implementation of technology to drive greater efficiency, productivity and customer experience.
- Ensure a culture of affordability, drives leadership principles among people managers, and ensures team actions are in place to make Blue Shield a great place to work.
- Ensure teams have daily to weekly team meetings and reviewing operational metrics and department goals.
- Ensure front line staff receive weekly to monthly one on one coaching celebrating successes and discussing opportunities for improvement.
QualificationsYour Knowledge and Experience
- Current CA RN License. LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences.
- Advanced degree preferred commensurate with field.
- Master's Degree preferred in a healthcare field.
- Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.
- Requires at least 10 years of prior relevant experience (UM, CM, BH).
- Utilization Management, Case Management, and Behavioral Health experience at a health plan preferred.
- Requires a minimum of 10 years combined experience managing projects, programs, complex changes initiatives, and/or CMS, NCQA, DHCS audits and regulatory compliance.
- Requires a minimum of 10 years' experience in developing and executing strategic business plans and budgets with a track record of achieving results.
- A minimum of 6 years of experience successfully managing people and leading teams.
- Requires strong knowledge of CMS and MediCal regulation rating systems (i.e., NCQA, Stars, QRS).
Pay Range: The pay range for this role is: $ 165990.00 to $ 248930.00 for California. Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. #LI-MM1 About the Team Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen. Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values: - Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model: Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work. Two ways of working: Hybrid (our default) and office
- Hybrid - In a business unit approved office a few times per year to 3 days per week, on average
- Office - In a business unit approved office 4+ days a week, on average. If the role you're applying for is deemed an Essential Role, the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.
Equal Employment Opportunity: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.