Director, Behavioral Health-Ohio Market

Job Summary:

Senior Director, Behavioral Health – Market, is accountable for achieving all Behavioral Health (BH) business goals across all products in assigned Markets, including value (profit and loss), outcomes (Market pay for performance, STAR rating and accreditation), and experience (compliance, access and retention) targets/goals.

The Senior Director is responsible for achieving the cost, quality, and outcomes goals in large/complex Markets, with the following:

  • High revenue (>$500 million in BH service revenue) and/or
  • High volume of BH claims (>5 million) and/or
  • High volumes of BH specialty provider groups (CMHCs) operating in the Market (>200) and/or
  • Complex BH benefits (>3 BH fee schedules)

Essential Functions:

  • Accountable for strategy and execution of cost and quality business deliverables for BH services within Market through aligning, developing, managing, and reporting goals, objectives, and status of Market BH program objectives, goals, and metrics, across all products in the Market
  • Responsible for BH advocacy, in collaboration with Market’s government affairs and regulatory leads to advance CareSource’s mission and goals and meet Market specific advocacy goals, across all products in the Market
  • Responsible for identifying and ensuring execution and implementation of all state and business operational, clinical and programs requirements across all products in the Market
  • Accountable for all specialty (CBHC), IMD (standalone hospital) relationship management and communication needs
  • Responsible for execution of Value Base Reimbursement (VBR) models for BH providers/groups or BH components of VBR models for non-BH providers/groups in the Market, up to and including Accountable Care Organization (ACOs), across all products in the Market
  • Responsible for execution and implementation of CareSource’s Market BH provider, pharmacy, and health partner programs through and within the Market’s health partner initiatives
  • Responsible for collaborative BH relationship management for “integrated” hospital and Outpatient providers, depending on Market needs
  • Responsible for ensuring compliance with Market Provider agreement, for each product in the Market, including the development of appropriate policies, practices and procedures as well as ongoing monitoring and reporting
  • Consults with Clinical Operations Leadership on execution and implementation of CareSource’s BH member care programs through and within the Market’s population health programs and initiatives, across each product in the Market
  • Consults with Market and Enterprise leadership to improve quality for members through collaborative execution (with Market and BH Enterprise departments) of BH quality improvement activities, including HEDIS, performance measures, etc. 
  • Consults with Market and Enterprise staff to ensure BH development and training though identification, development and implementation of content development initiatives and programs
  • Consults across Markets to engage in collaborative BH improvement activities including program planning, analytic review, and communication
  • Regular travel to conduct member visits, provider visits and community-based visits as needed to ensure effective administration of the program
  • Perform any other job duties as requested

Education and Experience:

  • Bachelor of Science degree in business, management, nursing, health services, or equivalent years of relevant work experience is required
  • Master’s degree in Business Administration, Healthcare Management or related field is preferred
  • A minimum of ten (10) years of senior level experience in government programs, human services, sales and marketing, public relations, advocacy or community social services role or equivalent experience is required
  • A minimum of five (5) years of clinical experience in behavioral healthcare delivery and oversight is required
  • A minimum of five (5) years of Managed Care leadership experience is required
  • Experience with governmental and non-governmental organizations that impact public policy is required
  • Experience in implementing behavioral health programs in provider practices, and or across a state/market is required

Competencies, Knowledge and Skills:

  • Basic computer skills
  • Comprehensive knowledge base crossing all areas within the Health Services Areas including: Behavioral Health, Case Management, Medical Management, Integration and Pharmacy
  • Knowledge of governmental bodies and community-based organizations that impact the organization
  • Understanding and interpretation of and adherence to state and federal regulations
  • Strong organizational, analysis, and problem-solving skills
  • Strong relationship building skills
  • Strong verbal and written communication skills and public speaking ability
  • Strategic management skills
  • Leadership experience and skills
  • Knowledge of trends in healthcare, managed care, Medicaid, case management, medical management and quality improvement
  • Program Development
  • Change agent
  • Negotiation skills/experience
  • Able to work independently and within a team environment
  • Strong organizational and time management skills
  • Critical thinking and listening skills with strong attention to detail
  • Training/teaching and technical writing skills
  • Decision making/problem solving skills
  • Customer service orientation
  • Knowledge of the political and regulatory environments
  • Healthcare administration expertise

Licensure and Certification:

  • The Behavioral Health Administrative Director must possess an independent current, and unrestricted Ohio license to provide behavioral health services in the state of Ohio (medical director, doctor of osteopathic, registered nurse with advance practice registered nurse [APRN] licensure, psychologist, licensed independent social worker [LISW], professional clinical counselor [PCC], independent marriage and family therapist) with a minimum of five years of experience with the provision and supervision of treatment service for mental illness and substance use disorders.  The Behavioral Health Administrative Director must demonstrate knowledge and understanding of Ohio’s overall behavioral health system that includes mental health, alcohol and drug addition, and developmental disabilities services.

  • Employment in this position is conditional pending successful clearance of a driver’s license record check.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
  • Employment in this position is conditional pending successful clearance of a criminal background check.  If the criminal background results are unacceptable, the offer will be withdrawn or, if you have started in this position, your employment in this position will be terminated

Working Conditions:

  • Mobile Worker:  This is a mobile position, meaning that regular travel to different work locations is essential.  Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
  • Reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
  • May be required to travel greater than 50% of time to perform work duties.  A valid driver’s license, car, and insurance are necessary for work related travel
  • Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
  • Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources