Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Director, Behavioral Health Strategy & Operations
- 💼
- EmblemHealth
- 📅
- 15 hours ago Post Date
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.
Qualifications
- Bachelor’s degree required; graduate degree in related field preferred
- 10 – 12+ years of relevant, professional work experience, including 5+ years in the healthcare insurance industry
- Excellent understanding of Behavioral Health clinical & operations and business needs
- Experience with project leadership and management, including planning, execution, and monitoring projects
- Strong communication skills (verbal, written, interpersonal) to collaborate effectively with cross-functional teams and stakeholders; ability to drive collaboration and foster highly productive, functional relationships
- Demonstrated agility and ability to drive program completion in expedited timelines
- Excellent analytical and problem-solving skills, with the ability to interpret data and make data-driven decisions
- Proven experience in leading process improvement initiatives and driving change within a healthcare organization
- Ability to adapt to a fast-paced and evolving healthcare environment
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.