Director - Behavioral Health Operations - Meridian Health Plan - Detroit

Job description
This position is responsible for the operational leadership and integration of the Behavioral Health programs at MHP, including development of operational policy and procedures, setting and implementing department production goals, monitoring and measuring success of implemented strategies and the supervision, training, compliance and auditing oversight of all BH programs. The Director will also interface with all other operational units in regards to Operations, new program implementation, utilization management, customer service, Information systems, and program reporting. This position is responsible for ensuring that MHP’s programs are compliant with internal standards, all contracts, National Committee for Quality Assurance (NCQA), URAC or general accreditation standards as well as State and federal regulatory requirements.

Essential Functions:
Collaborates with the Behavioral Health Medical Director in the operational design, development, implementation and outcomes monitoring of a comprehensive and integrated Behavioral Health program at MHP, for both existing and emerging programs and lines of business
Leads operations, process improvement and outcomes monitoring design and implementation initiatives for the Department
Collaborates with the Corporate Operations Director in development and maintenance of an operationally aligned and integrated Behavioral Health department within the Corporate MHP organizational structure, while identifying and articulating any unique operational needs for appropriate procedural development and support.
Oversees the development, implementation and annual evaluation of corporate Behavioral Health operations, including the following:
Systems, processes, and training plans for prospective, concurrent and retrospective utilization review across all lines of BH business
Profiling and monitoring of Behavioral Health populations served
Member Services, Care Coordination and Communications policy compliance, plans and program or project implementation as required for operations
Oversight of written, electronic and portal communications development, member and provider education and correspondence policy, procedure, program design and implementation for all Behavioral Health lines of business, in compliance with Communications and Compliance policy and procedure
Reporting calendar and submission compliance coordination and oversight for the BH Department
Operational oversight of personnel performance in Care Coordination, Case Management, Tobacco Cessation, and Nutrition, including development of Departmental telephonic and documentation auditing plan and schedule
Oversee the identification, tracking, resolution and response to all denials and appeals in compliance with NCQA, URAC or general accreditation standards
Represents MHP at external meetings with provider groups to address issues, improve communication and educate providers regarding MHP’s utilization management, communications or operational processes.
Ensures that all department activities are in compliance with the NCQA, URAC or general accreditation standards, as well as State and federal regulatory requirements
Provides Behavioral Health leadership representation to the Utilization Management Committee, Corporate and state-specific Operations Committees and participate on other committees as appropriate.
Develops/maintains relationships with State Medicaid and Medicare Directors and other managed care BH directors.
Develop and monitor the budget for utilization management behavioral health activities and ensure that sufficient resources are assigned to meet department goals.
Prepares weekly, monthly and quarterly utilization management behavioral health reports for submission to the Medical Director of Behavioral Health, the leadership team and the Board of Directors.
Serves as a liaison for the health plan concerning Behavioral Health Departmental activities, including participation in external meetings, work groups of Committees, and coordination with external entities
Maintains strict confidentiality of employee and organizational information in accordance with HIPAA and State privacy regulations
Performs other duties as assigned
In collaboration with the Medical Director, develop and oversee operational plans to assure integrated, timely and appropriate behavioral health services with the physical healthcare that members receive, including complex care, special needs and developmentally disabled populations.
Develops and oversees operational implementation of integrated pharmacy reporting and intervention initiatives in collaboration with the MH Medical Director and Meridian Rx Vice President of Operations to meet HEDIS objectives and to comply with state reporting or accreditation requirements

Desired Skills and Experience
Bachelor’s degree in a health care related field with strong related experience or additional Fellow designation from the Academy of Healthcare Management (AHM) with is required. A minimum of five years professional operations management experience is required. Experience in operational program design, implementation and process improvement is required. Experience in data management, interpretation and presentation design in required. Five (5) years managed care management experience is required. Public sector managed care or services management experience is preferred. Previous personnel management and supervisory experience is required. Knowledge of the NCQA, URAC or general accreditation standards for managed care organizations. Knowledge of health care utilization management processes and documentation. Knowledge of authorizations and claims data. Knowledge of Call Center and Customer Services principles, policies, procedure and operations.

Enter your email address:

Refer This Job To Your Friends And Help Them To Find Jobs!