Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

The Director, Behavioral Health Operations role is responsible for the oversight, coordination and continuous improvement of the Behavioral Health Portfolio, initiatives, and operations. This position promotes high inter- and intra-departmental collaboration and integration to advance strategic plan development and deployment and operational implementation of priorities impacting Behavioral Health across all business lines.

Essential Responsibilities

Technical/Operational Leadership

• Leads the execution, management, and oversight of strategic initiatives, plans, and goals in behavioral health operations.
• Oversees the effective integration and execution of behavioral health policies and activities across all lines of business, ensuring alignment with state and federal regulations and strategic business initiatives.
• Ensures effective, efficient, and compliant Behavioral Health plan operations in partnership with leaders from various CareOregon operational business units, through individual contribution and by deploying BH Operational Team resources.
• Pursues administrative simplification by identifying opportunities to integrate behavioral health operations with operational units of CareOregon for other benefit types.
• Ensures regulatory compliance for all areas of responsibility, leveraging advanced knowledge and understanding of Medicaid, Medicare and Managed Care regulations, industry trends, current best practices, new developments, and applicable laws regarding assigned departments for operational and financial effectiveness.
• Recognizes, adopts, and implements continuous quality improvement (CQI) best practices and metrics to obtain desired strategic and tactical results.
• Provides guidance, content expertise, and technical assistance to CareOregon's partner CCOs, providers and community-based behavioral health and primary care organizations.
• Creates and monitors dashboard and leverages service and population data and utilization and outcomes analytics to help assure CareOregon's and its CCO partners' success in meeting internal and external benchmarks.

Strategic/Operational Planning

• Participates in the development of vision, goals, and strategic plans for the department.
• Provides input into the strategic plans of the organization.
• Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.
• Provides input into strategic plans of the organization.
• Maintains a business unit and member view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

• Recommends budgets in alignment with short and long-term plans.
• Manages resources to ensure priorities are accomplished.
• Approves resource allocations within budget, including people, finances, and timelines; makes decisions on exceptions.

Relationship Management

• Leads effective communication system for work groups, ensuring a collaborative culture.
• Builds and ensures effective relationships and communication system across internal teams and external organizations for collaboration and current or future integration.
• Partners with internal leaders and managers in identifying improvement plans and processes.
• Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.

Employee Supervision

• Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
• Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
• Identifies department priorities; ensures employees have information and resources to meet job expectations.
• Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
• Manages, coaches, motivates, and guides employees; promotes employee development.
• Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
• Ensures team adheres to department and organizational standards, policies, and procedures.
• Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
• Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 10 years' related experience, including the areas of behavioral health, quality, and/or operations

Preferred

• Minimum 4 years' experience in a supervisory position
• Advanced degree in health care related field
• Certification in Healthcare Quality (CPHQ) or Healthcare Compliance (CHC)
• Work experience with Oregon Medicaid and/or OHP behavioral health benefits

Knowledge, Skills and Abilities Required

Knowledge

• Comprehensive knowledge of Medicaid and Medicare regulations for health plans and network providers regarding compliance, quality assurance and operations
• Solid knowledge of health plan finance and the compensation arrangements between health plans and providers

Skills and Abilities

• Ability to lead teams in researching, understanding, interpreting, and communicating federal and state requirements, including the Code of Federal Regulations, Oregon Revised Statutes and Administrative Rules

• Ability to influence and build consensus
• Results-oriented with a high attention to detail, ability to multi-task, and meet deadlines in a demanding, fast-paced environment
• Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level
• Superior critical thinking, analytical and problem-solving skills
• Ability to work independently absent explicit directions; excellent judgment
• Ability to contribute to a strong team-based environment in an environment with diverse individuals and groups

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#MULTI

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.