CareFirst Careers

Director, Behavioral Health Services

Resp & Qualifications

PURPOSE: Director, Behavioral Health Services acts as the expert clinical practitioner responsible for providing direct management and oversight of all behavioral health services to include all functions of behavioral health care management and the programs and services that support the behavioral health and substance use disorder patient care populations. The Director of Behavioral Health Services has accountability for all behavioral health clinicians, both telephonic and in the field, that are coordinating the care of the behavioral health and substance use disorder population. In addition, the Director of Behavioral Health Services has accountability for CareFirst's Behavioral Health and Substance Use Disorder Program and any future behavioral health programs related to this specialty. CareFirst's Behavioral and Substance Use Program is carried out in close coordination and integration with CareFirst’s suite of Care Support Services and Patient Centered Medical Home Programs. 

The Director will manage business strategy and day-to-day operations for a range of behavioral health programs and will work closely with other Care Management leaders in the organization on the design, implementation and outcomes evaluation of these programs.  The Director will work closely with vendor and provider partners to ensure that the programs are followed to contract requirements and to develop and maintain business relationships in the provider communities to ensure optimal performance of the programs.  The Director will work closely with CareFirst’s Strategic Business Units to communicate the value of these programs to our Members. 

PRINCIPAL ACCOUNTABILITIES:  Under the general direction of the VP of Care Management, the incumbent’s accountabilities include, but are not limited to, the following:

Strategic and Operational Management of Behavioral Health Programs.

 

  1. Oversees and manages all day-to-day operations of CareFirst’s behavioral health programs.  Ensures that programs are operating at full capacity and meet the strategic goals of the company.  Identifies ways to improve program performance and oversee the collection and integration of clinical and other program data into existing CareFirst IT infrastructure to ensure compliance and maximum impact of the program.  Develops a thorough understanding of which CareFirst Members would benefit the most from the programs and develops effective strategies to engage CareFirst Members in them. Partners with existing evaluation and data analysis teams to measure the value of all programs, including cost savings and clinical outcomes. The incumbent directs the quality review and quality improvement initiatives of behavioral health services and programs to support improved outcomes and reduced costs for CareFirst’s members. Conducts quantitative and qualitative analyses to assess effectiveness of all aspects of care coordination and the programs that support related to Behavioral Health and/or Substance Use Disorder. Interprets and implements policies and procedures to monitor adherence standards for behavioral health care coordination for CareFirst/CareCo.
  2. Works closely with PCMH and Care Management teams to design and execute programs to have greatest programmatic impact.
  3. Provides frequent updates to CareFirst’s Executive Leadership on the performance of these programs.
  4. Leads the creation and development of new clinical programs related to Behavioral Health and Substance Use Disorder. Serves as a liaison with other departments and divisions for development and implementation of programs, products and activities. Develops and implements programs for education. Oversees compliance with Mental Health Parity
  5. Represents Behavioral Health support programs in CareFirst quality and productivity initiatives such as the Quality Improvement Committee, HEDIS, the quality scorecard (clinical) and population identification & stratification.
  6. Establishes, implements, and maintains evidenced based clinical protocols and pathways for behavioral health and substance use disorder conditions with an emphasis on enhanced clinical excellence and optimal patient outcomes that lead to decreasing the cost of care. Serves as clinical resource and ensures adherence to policies and procedures.
  7. Recruit, develop relationships and oversee vendor relationships. 
  8. Develops and grows strategic relationships with a range of vendor and provider partners who carry out care support programs under his/her purview.  Engages in constant communication with our vendor partners to communicate the value of our programs and how to improve the quality of care. Continually assesses the performance of vendor partners to adhere to our guidelines and contract requirements and to assess their quality of care for CareFirst Members.  Develops formal and informal mechanisms to provide performance feedback to vendor and provider partners.


Staff Management

Recruits, retains and develops high performing teams of clinicians and other business professionals related to the delivery of a continuum of behavioral health and substance use services and programs. 
• Makes decisions regarding the hiring, promotion, development and termination of team members.
• Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. 
• Evaluates the performance of each team member, generates development plans and sets goals within the context of corporate policy. 
• Provides coaching, counseling and motivation to team members ensuring staff has the appropriate tools and training. 
• Identifies resource needs.


QUALIFICATION REQUIREMENTS:
Requires a master’s degree in Mental Health; education can be in one or more of the following areas:  Social Work, Psychology, Nursing or Counseling.  A minimum of eight (8) to ten (10) years post masters clinical behavioral health/psychiatric experience required and at least 5 years of progressively increasing leadership responsibility.  
License requirements: LCSW-C or LCMFT or LCPC in Maryland, DC or VA and ability to meet credentialing requirements for professional practice (Masters level licensed behavioral health professional).

In addition:
• Extensive knowledge of managed care delivery guidelines and systems.
• Extensive knowledge of behavioral health diagnoses.
• Demonstrated application and knowledge of best behavioral health clinical practices.
• Demonstrated qualitative and quantitative analytical ability.
• Demonstrated knowledge and understanding of the trends and forces shaping the healthcare delivery system, the provision of care, and other emerging issues in healthcare management and behavioral health management.
• Demonstrated advanced knowledge and skills in the areas of clinical expertise, evidence-based practice, and providing the related consultation, education, mentoring.
• Requires ability to model excellence in advanced behavioral health clinical practice within a specialty population.
• Proven record of management and leadership experience is critical. 
• Requires the ability to communicate and collaborate effectively with all members of the multidisciplinary team, promote teamwork, facilitate and lead work groups.
• Excellent analytical and problem solving skills, excellent organizational, communication and coordination skills.
• Effective presentation, negotiation and influencing skills to interface with all levels of staff, management and physician practices.  
• Ability to apply complex problem solving abilities to achieve problem and process solutions. 
• Skilled at being persistent, modifying tactics based upon reading another person’s statements and body language.
• Familiarity with web based software application environment.
• Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.   Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Preferred:
Doctoral degree in Psychiatric Nursing or Mental Health. 
 

Department

Hospital Transition of Care

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 09/28/2019

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

• The physical demands described here are representative of those that must be met by the incumbent to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities.
• Must be able to work in an office setting, primarily seated while performing duties for a minimum of 8 hours per work day.
• Must be able to provide own transportation to drive regularly to physician’s office and to satellite CareFirst Blue Cross Blue Shield offices.
• Walking and standing is required.  Lift weight up to 25 pounds on occasion.
• Hands are regularly used to write, type, key and handle or feel small controls and objects.  Must be able to type and to speak on the telephone simultaneously.
• Must have the ability to communicate verbally effectively. Auditory ability to actively listen.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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