This position is responsible for directing, planning, and organizing the Behavioral Health Clinical Operations area of the Behavioral Health department specific to all HCSC Government products, including but not limited to BCBSNM Centennial, Illinois Medicaid-Medicare Alignment Initiative and Medicare Advantage Prescription Drug Program.
Specific functions include providing assistance to the Divisional Vice President in the inclusion, involvement, management, and visibility of the Government Clinical Operations department, both internal and external to HCSC, in all clinical areas;
Providing leadership in the management of the clinical areas; representing the department to internal personnel and external key stakeholders such as providers, regulatory bodies, members and customers; directing the inclusion of behavioral health expertise throughout the enterprise in all clinical areas and external entities; and accountable for budgetary goals being met.
* Licensed Masters level medical/behavioral health professional in good standing.
* 10 years experience in behavioral health care with at least 5 years managed behavioral health care
* 5 years management experience including hiring, performance review, and oversight of budget.
* Experience directing the work of behavioral health care professionals in the area of medical necessity determination.
* Experience applying NCQA standards, URAC requirements and state and federal health insurance regulations.
* Leadership and organizational skills.
* Verbal and written communications skills to include delivering presentations to committees and acting as company representative to key stakeholders including providers, regulatory bodies, etc.
* PC experience to include Microsoft Office suite of applications (Word, Excel and PowerPoint) and databases.
* Able and willing to travel, including overnight stays (approximately 15 overnight travel).
* Project management experience including leading projects.
PREFERRED JOB REQUIREMENTS:
* 3 years management experience in Government Programs
Job ID: BDP-1024776