ABOUT THE ROLE

The Director, Behavioral Health will collaborate with clinical leaders to build and implement solutions that align with Bright’s overall clinical management strategy and deliver excellent compliance and medical cost results in alignment with Bright Health’s Care Partner strategic approach.

The Director, Behavioral Health is responsible for building and leading a team responsible for the execution of behavioral health clinical program and services, in close collaboration with Behavioral Health Medical Directors, and the Bright Health Network Development and Compliance teams. This is a senior role within Bright Health’s Clinical Leadership accountable for establishing and operating the new Behavioral Health team. This includes program development, design, outcomes measurement, and evaluation of programs for all lines of business. Leads the identification and initiation of process improvements and implementation of projects for new services, contract requirements, clinical outcomes and regulatory requirements. Develops and monitors training for compliance, market and operations growth and expansion as well as product development as it relates to behavioral health. 

YOUR RESPONSIBILITIES

• Build, evaluate, lead, monitor and oversee Behavioral Health teams and solutions for utilization management and care management that yield industry-leading medical cost and quality outcomes while aligning with Bright’s Care Partner philosophy
• Lead the development and implementation of compliance activities for Federal and State regulations including Mental Health Parity, as well as URAC and NCQA accreditation as they related to Behavioral Health
• Oversees the development of reporting and contributes to the measurement and evaluation of ongoing behavioral health programs performance
• Reports behavioral health program performance and operational updates to governance committees (i.e. UM, Quality Committees, Compliance)
• Collaborate with Network Development, Compliance, and Clinical Leaders to establish clinical operational and policy strategies that enhance program performance and align with Bright Health’s core objectives, policies and values including clinical and financial outcomes, member engagement and satisfaction
• Collaborate, coordinate and facilitate with the Clinical Delivery teams and any vendors or delegated entities for Care Management and Utilization Management to operationalize and execute clinical programs
• Maintain communication with departmental leadership, with routine updates on operations, issues, concerns, and other pertinent information
• Analyze trends and implement behavioral health initiatives based upon data provided through the reporting of utilization management, quality, and audit data
• Identifies areas of opportunity for improving access to, and quality of, BH services for members
• Coordinate and collaborate with other departments responsible for function aspects of behavioral health programs including Quality, Care Management, Care Navigation, Clinical Market teams, Claim Ops, Line of Business/Product leaders, Provider Network, Markets, Member/Provider Services and Broker/Enrollment services to identify opportunities to smooth the member and provider experience across programs

SUPERVISORY RESPONSIBILITIES

• This position has supervisory responsibilities for members of the Behavioral Health program team

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• A Bachelor’s degree in a related field is required, Master’s degree is preferred
• An RN, LCSW or other clinical licensure is preferred, but not required
• Ten or more years of professional experience, including five years developing and/or managing clinical programs, products and services is required
• At least two years of experience working within a utilization management and/or care management operation is required; Experience working in managed care setting preferred
• Prior experience with URAC or NCQA accreditation is desired
• Formal training in Six Sigma, LEAN or other project management techniques is a plus, but not required
• Proficient in MS Office; strong analytical skills are required

PROFESSIONAL COMPETENCIES

• Strong operational mindset and ability to use data to draw insights
• Thrive and drive results in a collaborative environment
• Strong ability to communicate in written and verbal presentations
• Strong team leadership skills
• Exceptional Organizational skills
• Excellent Functional skills

ABOUT US

At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.

We’re Making Healthcare Right. Together. 

We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

BRIGHT ON!