Sr. Director, Behavioral Health Operations Oversight
California Physicians' Service - Long Beach, CA
posted 4 months ago
About the position
The Senior Director, Behavioral Health Operations Oversight ensures behavioral health program integrity and compliance with state and federal regulatory standards and accreditation standards. This position works closely with management and employees to facilitate compliance with applicable federal and state regulatory requirements. In this role, you will serve as a business driver for enterprise-wide behavioral health initiatives and mandate implementations. You will direct behavioral health projects, initiatives, executive-sponsored initiatives, responses to regulatory audits, accreditations, on-site reviews, and risk assessments to support behavioral health compliance. Additionally, you will oversee all behavioral health compliance committees for all lines of business. You will lead internal monitoring to identify behavioral health process gaps, validate behavioral health operational compliance levels, map processes, draft corrective actions/remediation plans, oversee the implementation of corrective actions, and prepare reports and presentations. Developing strategic plans and making recommendations to leadership will be a key part of your responsibilities, as well as designing and implementing an annual clinical operations compliance plan. Building strong relationships with key leaders to identify and address regulatory risks and failures will be essential, as you will be accountable for action plans designed to fully mitigate risks. Your role will also involve reviewing and analyzing regulations to determine their impact on plan behavioral health operations and identifying the need for new or revised policies, procedures, and plan documents. You will establish an annual work plan for ongoing review of all behavioral health-related operations to ensure regulatory compliance standards are met and any issues found are corrected. Furthermore, you will design behavioral health regulatory compliance training and materials, review and develop policies and procedures from a compliance perspective, and maintain annual review and management of these policies and procedures. In collaboration with compliance and regulatory affairs teams, you will prepare communications and reporting with regulatory agencies such as DMHC filing submissions, regulatory reporting, and ad-hoc requests, and participate in regulatory meetings as they pertain to behavioral health.
Responsibilities
- Serves as business driver for enterprise-wide behavioral health initiatives and mandate implementations.
- Directs behavioral health projects, initiatives, executive-sponsored initiatives, responses to regulatory audits, accreditations, on-site reviews, risk assessments to support behavioral health compliance.
- Oversees all behavioral health compliance committees for all lines of business.
- Leads internal monitoring to identify behavioral health process gaps, validate behavioral health operational compliance levels, map processes, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations.
- Develops strategic plans, makes recommendations to leadership; designs/implements annual clinical operations compliance plan.
- Develop strong relationships with key leaders to identify and address regulatory risks and failures. Accountable for action plans designed to fully mitigate risk(s).
- Reviews and analyzes regulations to determine the impact on plan behavioral health operations and identifies the need for new or revised policies, procedures, plan documents.
- Establishes an annual work plan for ongoing review of all behavioral health-related operations to ensure regulatory compliance standards are met and any issues found are corrected.
- Designs behavioral health regulatory compliance training and materials; Reviews and develops policies and procedures from compliance perspective and maintains annual review and management of policies and procedures.
- In collaboration with compliance and regulatory affairs teams, prepares communications and reporting with the regulatory agencies such as DMHC filing submissions, regulatory reporting, and ad-hoc requests.
- In collaboration with compliance and regulatory affairs teams, participates in the DMHC and DHCS regulatory meetings as they pertain to behavioral health.
- In collaboration with compliance and regulatory affairs teams, prepares routine regulatory reports and analysis to include, but not limited to, Department of Health Care Services (DHCS); Department of Managed Health Care (DMHC); the California Department of Public Health (CDPH); Centers for Medicare and Medicaid Services (CMS).
- Other duties as assigned.
Requirements
- Requires a Bachelor's degree, and a minimum of 12 years prior relevant experience in a managed care healthcare setting with experience in Compliance, HIPAA/Privacy, FWA and/or Regulatory Affairs operations preferred, including 6 years of management experience.
- Master's degree in relevant field preferred (e.g., clinical psychology or similar).
- Certificate of Healthcare Compliance (CHC) preferred.
- Requires in-depth knowledge of quality and change management process.
- Expert knowledge of state behavioral health regulatory requirements under the Centers for Medicare & Medicaid Services, Department of Managed Health Care and Department of Health Care Services.
- Expert knowledge of privacy laws applicable to health plans.
- Strong analytical skills, including the ability to interpret and determine the impact of complex laws, regulations, and other documents.
- Knowledge of regulatory external audits, internal auditing and effective implementation, control, and monitoring processes.
- Strong interpersonal skills with the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside the Health Plan.
- The ability to independently achieve objectives and resolve issues under ambiguous circumstances is a must.
- Strong decision-making, organizational, planning, and problem-solving skills, and communication skills are needed to effectively interact with staff, team members and others in a professional and tactful manner.
- Ability to supervise staff in a manner that maximizes employee performance and business results.
- Strong presentation skills with the ability to tailor presentations to a specific audience, and address and interact with large groups.
Nice-to-haves
- Experience in a nonprofit organization.
- Familiarity with behavioral health programs and services.
- Knowledge of California healthcare regulations.
Benefits
- 20 days of paid time off (PTO) per year for Senior Managers and below.
- Flexible Time Off (FTO) for Directors and above.
- 10 paid holidays per year.
- 24 hours of paid time off to use for community service.
- 12 weeks of paid parental leave.
- Free online education at University of Arizona Global Campus.
- Tuition reimbursement and student loan discounts.
- Matching gift contributions to select charities.
- On-site fitness facilities and fitness programs in select locations.
- 4-week paid sabbatical program after five years of service.
- Child and elderly backup care.
