Responsible for building and leading a team to execute EmblemHealth’s behavioral health clinical program and services, in close collaboration with Behavioral Health Medical Directors, Care Management teams and senior leaders. Accountable for establishing and operating a clinically integrated Behavioral Health program and model of care. This includes program development, design, outcomes measurement, and evaluation of programs for all lines of business in collaboration with clinical delegates and vendors. Lead the identification and initiation of process improvements, collaborations and implementation of projects for new services, contract requirements, clinical outcomes and regulatory requirements. Develop and monitor training for compliance, clinically integrated best practices, market and operations growth/expansion as well as product development as it relates to behavioral health.
• Launch, lead, monitor and oversee Behavioral Health clinical programming and solutions in collaboration with in-house and outsourced care management and utilization management functions to yield industry-leading medical cost and quality outcomes while aligning with EmblemHealth’s values and mission.
• Lead the development and implementation of compliance activities for Federal and State regulations including Mental Health Parity, as well as URAC and NCQA accreditation as they related to Behavioral Health.
• Oversee the development of reporting and contribute to the measurement and evaluation of ongoing behavioral health programs performance.
• Collaborate with Clinical Leadership, Provider Network Management, Compliance, Product and Delegate Oversight to establish clinical operational and policy strategies that enhance program performance and align with core objectives, policies and values including clinical and financial outcomes, member engagement and satisfaction.
• Collaborate, coordinate and facilitate with the Clinical teams and any vendors or delegated entities for Care Management and Utilization Management to operationalize and execute clinical programs.
• Report behavioral health program performance and operational updates to governance committees (i.e. UM, Quality Committees, Compliance).
• Maintain communication with departmental leadership, with routine updates on operations, issues, concerns, and other pertinent information.
• Analyze trends and implement behavioral health initiatives based upon data provided through the reporting of utilization management, quality, and audit data.
• Identify areas of opportunity for improving access to, and quality of, BH services for members. Coordinate and collaborate with other departments responsible for function aspects of behavioral health programs including Quality, Care Management, Claims, Operations, Product leaders, Provider Network, Marketing, and Enrollment services to identify opportunities to smooth the member and provider experience across programs.