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Full-time AVP, Behavioral Health Strategy & Clinical Services

at BCBS of Rhode Island in Rhode Island

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, gender identity or expression.

Provide strategic direction and lead the development, implementation and maintenance of a comprehensive behavioral health strategy and program for BCBSRI. This includes the implementation and management of the strategic vision for behavioral health and the establishment and tracking of key quality and performance indicators.

Responsible to provide liaison and coordination with community based providers and facilities, BCBSRI’s Health Management Integration Department, Patient Centered Medical Homes, and other health management and improvement programs. Provide oversight management of the behavioral health management vendor and other applicable contracted vendors. This position assists in the achievement of organizational financial and business objectives in maintaining affordability, and in ensuring quality services are provided to all stakeholders.

REPRESENTATIVE JOB DUTIES (listed in order of importance):
- Leads the direction and day-to-day management and operation of the behavioral health program. This includes the development and maintenance of the key strategic initiatives within the behavioral health strategic focus.
- Provides liaison direction and information to senior leadership for behavioral health issues and operations.
- Provides leadership and guidance to key behavioral health program staff including the BH Medical Directors, and other designated associates including quality improvement, data analytics staff, provider relations, and care management.
- Oversees non-regulatory components of BCBSRI’s behavioral health manager for accountability and assistance with meeting the goals and measures outlined in BCBSRI’s behavioral health strategy.
- Provides regular reporting for the BH program including annual plan, quarterly reports, and ad hoc information to all internal committees including, but not limited to BCBSRI’s quality oversight committee, Medical Expense Trends Team and Network Strategy Team.
- Collaborates with BCBSRI’s Network Management team regarding provider contracting and network development.
- Ensures coordination of operational and clinical issues associated with the delivery of services, including quality initiatives, customer service response, benefit application issues.
- Acts as the lead BCBSRI representative at quarterly performance report meetings with community providers.
- Oversees the development of an annual behavioral health quality plan and provides direction for the review and implementation of quality initiatives.
- Participates or delegates role for membership on key BCBSRI committees to ensure behavioral health integration in all aspects of BCBSRI’s business.
- Consult with staff from all key internal departments. Responsible to facilitate timely and accurate responses and recommendations to internal staff.
- Works with all internal training staff/departments to ensure behavioral health programs, benefits and initiatives are disseminated effectively throughout the organization.
- Serves as a liaison to Corporate Compliance and Ethics Department and Government Programs on issues related behavioral health requirements and programs.
- Performs other duties as assigned.

Minimum Education and Experience:
- Advanced degree or notable experience in healthcare management and business operations.
- Ten or more years of behavioral health experience in a healthcare delivery, management, or payer systems, with specific background and knowledge of the Managed Care industry.
- Seven to ten years of experience with building and managing complex quality focused behavioral health networks and programs.
- Seven or more years of progressive management experience.

Preferred Education, Additional Qualifications and Experience:
- Advanced clinical degree (doctorate or masters) in behavioral health, or related field is required.
- Strong understanding of the regulatory environment as it relates to behavioral health on a national level, and specific to Rhode Island.
- Master of Public Health or Master of Business Administration degree.

Required Knowledge, Skills, and/or Abilities:
- Knowledge of clinical, business, and quality operations of managed behavioral healthcare
- Knowledge of RI State laws and regulations for health insurance utilization review and care management
- Knowledge of behavioral health and health plan benefits and programs
- Knowledge of quality improvement, benchmarking, and program evaluation
- Knowledge of network development and management strategies
- Knowledge of vendor management
- Knowledge of regulatory, accreditation, and State and Federal compliance requirements
- Knowledge of industry benchmarks and resources
- Strong leadership and organizational skills
- Analytical skills including database development and management
- Proficient in Excel, PowerPoint and Word
- Well-developed management skills
- Excellent verbal, written and analytical skills
- High degree of human relations skills
- Contract negotiation skills
- Ability to handle sensitive matters professionally and confidentially.
- Ability to provide motivation and leadership for staff.
- Ability to provide senior leadership with useful and actionable data and reports.
- Ability to deliver complex data in an articulate manner.
- Ability to take initiative in finding solutions to difficult and/or sensitive problems

How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://bcbsri.contacthr.com/20849757


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Published on Aug 11, 2011
Viewed: 1704 times