Summary of Position

Translate behavioral health strategy into actionable initiatives, operating plans, and measurable outcomes, ensuring alignment with enterprise priorities and business objectives. Serve as the primary business owner for behavioral health vendor relationships, providing strategic direction, operational oversight, and accountability for program performance. Establish and lead vendor governance structures, including performance reviews, escalation processes, and executive reporting to ensure achievement of contractual obligations and business goals. Monitor and evaluate vendor performance through service, quality, operational, financial, and member outcome metrics, driving corrective actions and continuous improvement as needed. Lead implementation and optimization efforts for behavioral health programs and services, partnering with vendors and internal stakeholders to ensure successful execution and value realization. Identify, assess, and mitigate operational, financial, compliance, regulatory, and service delivery risks associated with behavioral health programs and vendor partnerships. Develop business cases and strategic recommendations to optimize behavioral health capabilities, including opportunities to expand, redesign, consolidate, transition, or insource services. Foster collaborative partnerships with Clinical, Operations, Network, Product, Finance, Compliance, and vendor leadership teams to improve access, quality, affordability, member experience, and clinical outcomes.

Principal Accountabilities

• Serve as business owner for behavioral health vendor relationships and overall service delivery performance.
• Lead governance structures, including operational reviews, performance scorecards, and escalation processes.
  Monitor vendor performance against contractual obligations, service level agreements, quality measures, member experience metrics, and financial targets.
• Drive accountability and corrective action plans to address performance gaps, operational issues, compliance concerns, and member impact.
• Partner with Clinical, Operations, Network, Product, Finance, Compliance, Legal, and Clinical teams to support enterprise behavioral health objectives.
• Facilitate alignment across stakeholders to ensure successful delivery of strategic initiatives and operational priorities.
• Lead resolution of complex issues requiring coordination across internal and external partners.
• Prepare and present performance updates, risks, strategic recommendations, and program outcomes to senior leadership.
• Identify and mitigate operational, regulatory, financial, and service delivery risks associated with behavioral health programs and vendor partnerships.
• Ensure vendor activities comply with contractual requirements, regulatory standards, accreditation requirements, and company policies.
• Lead root cause analysis and remediation efforts related to audits, complaints, compliance findings, and operational performance issues.
• Promote a culture of accountability, innovation, and continuous improvement across behavioral health programs and partnerships.
• Partner with leadership to translate enterprise behavioral health strategy into actionable initiatives, operational plans, and measurable outcomes.
• Lead implementation, expansion, and optimization of behavioral health programs and services delivered through vendors and strategic partners.
• Evaluate program performance, utilization trends, member outcomes, and operational effectiveness to identify improvement opportunities.
• Develop business cases and recommendations to improve quality, access, affordability, operational efficiency, and member experience.
• Support organizational decisions regarding expansion, redesign, consolidation, transition, or insourcing of behavioral health services.

Qualifications

• Bachelors' Degree in related field, such as public health, Health Administration
• Masters' Degree or MBA preferred
• PMI Certification - Project Management Professional (PMP) preferred
• 8 - 10+ years' professional business experience, preferably in the Healthcare Payer business (Required)
• 5 - 8+ years' experience managing large and highly complex Healthcare Payer projects (Required)
• Experience with Vendor management (Required)
• Experience in Behavioral Health (Preferred)
• Ability to assess and develop risk mitigation strategy recommendations (Required)
• Strong understanding of project related business case development and cost benefit analysis (Required)
• Ability to build and maintain relationships with staff up to and including leadership (Required)
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
• Expert knowledge of Microsoft Office tools, (Excel, Word, PowerPoint, Teams, Outlook) (Required)