Director, Behavioral Health

Job Title

Director, Behavioral Health

Duration

Open until filled

Work Hybrid

Yes

Description

Let’s do great things, together!

About ModaFounded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position SummaryThis position provides strategic leadership, direction, and oversight of Moda’s Behavioral Health (BH) programs. Ensures that Moda BH programs provide value to our members and position Moda as a leader in the behavioral health care community and represents these programs to internal and external stakeholders. This is a full-time hybrid position based in Portland, Oregon. Pay Range$137,053.42 - $185,021.08 ​​​annually, DOE.Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position. https://j.brt.mv/jb.do?reqGK=27751960&refresh=trueBenefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability

• 401K- Matching

• FSA

• Employee Assistance Program

• PTO and Company Paid Holidays

Required Skills, Experience & Education:

• Current unrestricted Oregon license as mental health professional, (e.g., Registered Nurse, Psychiatric Mental Health Nurse Practitioner, Licensed Psychologist, Licensed Clinical Social Worker, Licensed Professional Counselor, Licensed Marriage and Family Therapist).

• At least ten years’ experience in behavioral health treatment and/or health plan setting, including five years in a supervisory or management position.

• Excellent verbal, written and interpersonal communication skills including ability to tailor presentations to varying audiences.

• Proficiency with Microsoft Word, Excel and typing. Familiarity with case management database software preferred.

• Knowledge of regulatory environment including Mental Health Parity.

• Knowledge of Utilization Management standards and practices.

• Sound clinical and practical judgment.

• Ability to utilize a systems framework in analyzing and solving problems.

• Ability to foster a healthy and productive work environment for employees.

• Ability to work overtime as necessary.

Primary Functions:

• Recommends strategic direction for Moda’s BH program to senior leadership; anticipates emerging trends, market demands, and opportunities.

• Leads development of new programs and ensures successful execution of initiatives.

• Ensures department standards, goals, objectives, and results are achieved by training, delegating, coaching, monitoring documentation, maintaining accurate records, and tracking outcomes.

• Establishes effective, collaborative working relationships with other departments such as Customer Service, Medical Professional Relations, Marketing, Claims and Compliance where there is shared procedural/policy interest.

• Develops and maintains relationships with external stakeholders including providers, state agencies, legislators and work groups, employer groups, and community groups.

• Oversees contracting and relationships with BH vendors.

• Serves as Behavioral Health subject matter expert in managing the client interface across all lines of business

• Provides subject matter expertise to Moda’s legislative committee; recommends positions on BH-related bills affecting Moda’s business; provides testimony to legislative committees and rulemaking advisory committees; provides information and analysis to Moda’s lobbyists and government relations teams.

• Advises and collaborates with Regulatory team regarding behavioral health benefits and regulatory issues. Provides key content and analysis for annual Mental Health Parity compliance reviews and submissions.

• Advises and coordinates with Medical Contracting and Medical Professional Relations teams regarding contracting activities and relations with behavioral health providers and facilities.

• Provides direction for value-based reimbursement initiatives related to behavioral health.

• Supervises Psychiatric Medical Consultants, BH Clinical Liaison, and BH Manager, providing guidance and mentorship, monitoring program performance, giving performance reviews.

• Provides leadership for development, organization, and implementation of behavioral health medical necessity criteria.

• Provides back-up to BH Manager in completing BH authorizations for Moda Health employees.

• Reviews and authorizes the planning, development, organization, and implementation of BH protocols, policies and procedures and Quality Improvement Projects (QIPs).

• Ensures accuracy and timeliness of BH of the monthly Medical Management reports to internal and external customers.

• Coordinates with other department directors to provide leadership for departmental efforts related to IT programs and needs.

• Oversees system for maintaining and upgrading configuration of department’s clinical database program (CT Dynamo).

• Performs other duties as assigned.

Working Conditions & Contact with Others

• Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need.

• Internally with all departments. Externally with providers, Oregon Health Authority, Department of Consumer and Business Services, legislators, vendors, members, brokers, employer groups.

Together, we can be more. We can be better. ​​​​​​Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler via our humanresources@modahealth.com email.