Director, Behavioral Health Care Management

Your Role

Blue Shield of California is looking for a clinical leader to oversee the behavioral health care management for all product lines. Reporting to the Sr. Director, Behavioral Health Clinical Operations, the role of the Director, Behavioral Health Care Management is critical to the success of Blue Shield of California and the Care Management department in realizing its goals and objectives. This individual will play a key role as part of Care Management team in delivering and collaborating on all aspects of care management and care coordination for behavioral health membership for all lines of business. This leader will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.

Your Knowledge and Experience

• Current unrestricted CA License: RN, LCSW, LMFT, LPCC, or Licensed Psychologist
• Requires a college degree or equivalent experience and minimum 10 years prior relevant experience, including 6 years of management experience
• Master's Degree in a healthcare field preferred
• Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field
• Requires working knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, CMS, DHCS)
• Requires knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirable
• Requires broad management knowledge to lead project teams in one department/function or large centralized function