DEPARTMENT(S): Executive Office
REPORTS TO: Chief Medical Officer (CMO)
FLSA STATUS: Exempt
SALARY GRADE: U - $226,000 - $338,000)
JOB SUMMARY
The Executive Director (ED) of Behavioral Health Integration (BHI) is responsible for oversight of CalOptima’s Behavioral Health (BH) program including utilization of services, quality outcomes, and the coordination and true integration of care between Physical and BH practitioners across all lines of businesses. The incumbent serves as a member of the executive team and, with the CMO, to ensures that Medical Management is aligned with CalOptima’s strategic and operational priorities. The incumbent is a key leader within the health plan and is accountable for leading the areas assigned to next-level capabilities and operational efficiencies consistent with the strategic plan, goals, and objectives for CalOptima. The incumbent will anticipate, continuously improve, communicate, and leverage resources and balance achieving set accountabilities with constraints of limited resources. The incumbent will be responsible for new program implementation related to initiatives in the above areas.
POSITION RESPONSIBILITIES:
- Accountable for strategy deployment, systems development, workflow development, ongoing operational compliance, and consistent delivery of results and metrics in the areas of oversight.
- Responsible for consistent operational compliance and timely reporting to satisfy and exceed state and federal standards; as well as being responsible for the identification, development, and implementation of best practices.
- Accountable for budget planning and adherence to fiscal processes that ensures the appropriate use of public funds.
- Responsible for communication, coordination and monitoring of organization-wide quality initiatives amongst Medical Management and other CalOptima departments, Health Networks, contracted BH service providers/vendors and external stakeholders.
- Leads the planning and implementation phases of new or enhanced products, programs, or pilots that will improve integration of physical and behavioral healthcare services.
- Directs BH program staff on operational matters and proposes solutions to operational issues and improvements related to services provided to members by other CalOptima departments, vendors/contractors, and Health Networks.
- Develops projects around person-centered care and applicable health related topics that will assist the agency in maximizing health outcomes and improving costs.
- Works with the Health Education department in the development of CalOptima sponsored trainings/seminars/conferences on BH topics.
- Works in tandem with the Medical Director of Behavioral Health in researching -specific policy issues, analyze options, and develop recommendations.
- Represents CalOptima on various community planning bodies and workgroups at the local, state, and national level.
- Ensures that policies and procedures necessary to operate the department comply with regulatory and accreditation requirements and are in place and updated no less than annually.
- Other projects and duties as assigned.
POSSESSES THE ABILITY TO:
- Build, maintain, and enhance relationships with the County of Orange, Providers, Health Networks, community-based organizations, and other key stakeholders.
- Develop department expertise in the analysis of BH data that will improve the overall health delivery system to utilize quality informatics, metrics, and quantitative analytics to identify areas for quality improvement activities and to measure the outcomes of interventions.
- Demonstrate strong leadership skills with the ability to influence and manage and foster a team environment.
- Quickly understand all major functions within the health plan environment and address issues globally.
- Communicate clearly and concisely, both verbally and in writing.
- Understand major objectives and break them down into meaningful actionable steps by problem-solving, analyzing and exhibiting organizational skills with attention to detail.
- Work in a dynamic environment with both short-term and long-term deadlines.
- Establish and maintain effective interpersonal relationships with all levels of staff, other programs, agencies, members, providers, and the general public.
- Prepare concise and clear documentation, including white papers, policies and procedures, project management, and teaching materials.
- Identify pertinent policy and programmatic issues as well as develop strategies, solutions, and recommendations.
- Manage, develop, and lead staff and numerous simultaneous projects to execute strategy and operation plans and their respective activities, timelines, and issues.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
EXPERIENCE & EDUCATION:
- Master’s degree in Behavioral Health or relevant field; or the equivalent combination of education and/or experience in directing a behavioral health program or a related field required.
- 10 years of Managed Care operations experience with 5 years related to Behavioral Health, at the plan level, required.
- 7 years of progressive leadership experience, including direct supervision of staff, in key functional areas of Behavioral Health required.
- Understanding of reporting environments, data configuration, business intelligence strategies and reporting strategic initiatives required.
- Experience building consensus required.
- Have access to a means of transportation for work away from the primary office approximately 5% of the time.
PREFERRED QUALIFICATIONS:
- Doctoral degree in Behavioral Health related field preferred.
- Current, active, unrestricted Psychology license to practice in the State of California preferred.
- Health Maintenance Organization (HMO), Medi-Cal/Medicaid, Medicare, and insurance experience or relevant government client or public service experience preferred.
- Experience giving reports to a Board of Directors and formulating and articulating short and long-term goals and strategies preferred.
- Experience presenting to member and provider advisory groups preferred.
KNOWLEDGE OF:
- Managed Care and public sector healthcare such as Medicaid.
- Principles and practices to promote communication and adequate information flow and to support overall management control systems.
- Principles and practices of managed healthcare, healthcare systems, and medical administration.
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
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Required Skills
Required Experience