Director, Behavioral Health Strategy & Operations

Summary of Position

Lead and drive high value Behavioral Health strategy and initiatives along with Behavioral Health clinical leader. Execute an organizational strategic plan for behavioral health. Identify areas for improvement, implement innovative solutions, and optimize processes to enhance efficiency, quality, and cost-effectiveness of behavioral healthcare. Collaborate with cross-functional teams, analyze data, and develop strategies to streamline operations and drive continuous improvement in behavioral health.

Principal Accountabilities

• Develop and execute the enterprise behavioral health strategy across all lines of business (Medicare, Medicaid, Commercial).
• Serve as operational lead in supervising Behavioral Health (BH) vendor, taking responsibility over Carelon and services provided by them to our members.
• Support integration between behavioral health and physical health to support whole-person care.
• Partner with internal operations, network, and analytics teams to design efficient workflows, reduce administrative burden, and enhance member outcomes.
• Oversee performance of internal and delegated behavioral health operations including care management, appeals/grievances, and quality reporting.
• Lead continuous improvement initiatives focused on access, timeliness, and member engagement.
• Monitor key performance indicators (PMPM cost, utilization, readmission rate, engagement rate) and drive accountability for results.
• Drive Performance improvement initiatives for access, quality and affordability.
• Monitor NYS-required settlement activities around service delivery and quality of patient satisfaction to ensure that providers in-network.
• Develop and lead behavioral health initiatives with leadership clinical and executive leadership.
• Support the innovation agenda for behavioral health, identifying and implementing emerging models of care, digital solutions, and community-based partnerships.
• Support the development of EmblemHealth's Behavioral Health member journey, optimizing access and member satisfaction. Develop complaint processes for members and providers with appropriate monitoring and mitigation of any ongoing issues.
• Determine and manage the effectiveness of EmblemHealth's behavioral health provider directory, maintaining the effectiveness of response to continual service evaluation.
• Direct provider manual adjustments and updates as well as member-facing content adjustments.
• Define key evaluation metrics for behavioral health program and manage outcomes across teams.
• Provide Behavioral Health thought leadership to plan and external stakeholders.
• Collaborate with Provider Network Management & Quality Management to design and operationalize new value-based model(s) with network providers.
• Manage & participate in various provider-facing Joint Operating Committee meetings with BH providers.
• Represent behavioral health externally and in appropriate regulatory meetings.
• Participate in behavioral health committees as well as participate in various cross functional committees.
• Establish and maintain continuity in the planning, development and implementation of policies, operational processes, workflows required to execute organizational strategies and to assure consistency in process application throughout Care Management.
• Validate and monitor adherence to implemented policies, procedures, workflows and processes: identify, recommend and implement improvement initiatives accordingly.