Job Summary
Provides leadership, direction and support for all aspects of the Behavioral Health program; ensuring that the organization’s care management policies reflect the concept of integrated behavioral/physical health services  Provides direction to all staff working within the Behavioral Health program to enable independent performance that conforms to established program guidelines.  The focus of this position is to pursue and achieve best practice in behavioral health care management, disease management, advocacy, and quality improvement programs to ensure consistent, efficient delivery of services, demonstrating positive outcomes, at the same time reducing costs, ensuring a high degree of member, physician and employee satisfaction, and optimal regulatory relationships and compliance.  The incumbent must have a strong service orientation and be able to foster strong relationships with Community Mental Health Centers, Federally Qualified Health Centers, hospitals, physicians, community agencies, regulatory and State agencies as well as internal departments and staff.  He/she must be skilled as a change agent and be able to work with all levels at CareSource.  This position requires significant travel between the corporate office, regional office as well as CMHCs, FQHCs, regulatory and State agency offices, and provider offices and field office sites.

Essential Functions
Works closely with the Senior and Executive Management team to develop and implement a comprehensive Behavioral/Physical Health Program. 
Works closely with the Senior and Executive Management team to accommodate the growth and expansion of the health plan.
Works closely with care management staff, medical management staff, behavioral health vendors, behavioral health providers and medical providers to assure integration of behavioral health and medical services.
Works closely with Senior and Executive Management team to develop recruitment and clinical training programs.
Supervise and mentor Care Management and Disease Management managers; develop and coach employees at all levels in the department.
Continuous review of business workflow to improve productivity and ensure member and provider satisfaction.
Prepare and monitor program budgets for the Behavioral Health program.  
Develop and communicate effective program policies and procedures.  
Identifies and initiates continuous improvement initiatives.  Monitor CQI activities in accordance with regulatory requirements and URAC standards.
Prepares an annual Behavioral Health program Work Plan and annual evaluation of Behavioral Health program activities. 
Monitors and evaluates the efficiency and effectiveness of behavioral health activities through analysis and use of relevant data and management reports.
Facilitate and promote problem identification, analysis and resolution.
Determine benchmarks, goals and outcomes for all programs as well as high cost, volume and risk conditions.
Implement an accountability system.
Ensure monitoring of regulatory requirements and oversight of all submissions.
Perform any other job related instructions as requested, with reasonable accommodation.
Chief responsibility for oversight of Behavioral Health vendors in conjunction with local plan leadership

Minimum Qualifications

Education
Master’s degree or equivalent education and professional experience in nursing, psychology, social work, counseling or related clinical area.

Experience
Five years’ experience in behavioral health case management, disease management and quality improvement in an MCO.
Experience with Community Mental Health providers.
Two years experience working in clinical inpatient and/or outpatient behavioral health setting.
Five years’ administrative/managerial experience. 
Experience in Medicaid MCO preferred. 
Certification: Current, unrestricted licensure/certification as required by field of specialty in Ohio, Michigan and other states if needed.
Experience in the design/implementation of integrated Behavioral/Physical Health clinical practice guidelines