CCO Behavioral Health Director

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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The CCO BH Director is responsible for leading the development and implementation of multi-year behavioral health (BH) transformation, improvement, and integration strategies in service to Medicaid enrollees managed by PacificSource. This position works closely with Coordinated Care Organization (CCO) Directors to develop, align and execute regional strategies. The CCO BH Director will build and execute plans in collaboration with regional Population Health teams, Provider Network, as well as provider and community stakeholders to ensure Medicaid enrollees have access to a comprehensive array of BH services, in accordance with OHA requirements. This position will also lead relationship-building strategies across PacificSource’s service areas to ensure that regional BH plans are integrated, connected to community BH and safety net services, and supported by community governance bodies. This role requires strong relationships, effective communication and excellent organizational skills to lead multi-stakeholder strategic planning efforts, as well as strong execution skills in order to effectuate internal or external work plans.

Essential Responsibilities:

• Identify opportunities to develop, strengthen, and expand access to robust, high value evidence based behavioral health services within assigned service areas, including all sectors of care delivery (e.g., primary care, specialty, hospital, dental, and community-based settings) in direct partnership with CCO Directors.
• Accountable for strategic development, implementation and oversight of a multi-year BH transformation and improvement strategy by leading efforts in collaboration with internal and external stakeholders such as Care Management, Population Health, Quality Improvement, and Provider Network along with providers and community partners (Regional CBHP)
• Lead development and oversee operationalization of integrated, outpatient, specialty and residential behavioral health strategies, along with programs that integrate physical and behavioral health.
• Manage key external relationships, create new innovative collaboration and integration opportunities, and serve as a key leader for provider interests, commitments, resource requirements, timelines and related action items relating to Behavioral Health.
• Serve as a BH matrixed leader to integrate BH into Compliance, Contracting, Provider Relations, Quality Improvement, Care Management, Utilization Management, Population Health, Training, and Provider Network.
• Represent the company in each CCO as subject matter expert and BH specialty leader, including informing BH training and education as needed.
• Remain informed and offer consultation regarding compliance to federal and state regulatory requirements related to behavioral health in each CCO, including activities performed within PacificSource and in conjunction with critical community providers.
• Collaborate to develop and deploy components of workforce plans, health equity plans, training plans, Transformation and Quality Strategy initiatives, and quality improvement initiatives.
• Oversee operationalization of community BH programs and services, including Wraparound, System of Care governance, ACT, mobile crisis, supported employment, etc.
• Demonstrate ability to successfully navigate in a matrixed organization, a history of executing in a fast-paced environment, and ability to remain accountable for deliverables while working in partnership with others throughout the organization.
• Analyze and interpret data in collaboration with other departments to identify opportunities for improved outcomes and cost savings across the continuum of care, and make recommendations for innovative BH initiatives and integrated health strategies.
• Actively lead or participate in various internal and external committees in order to provide behavioral health expertise and perspective, disseminate information, and promote BH transformation and improvement strategies.
• Responsible for the oversight, development, implementation and review of behavioral health plans, policies, procedures and other guidelines.
• Coordinate with other departments to understand and deploy needed BH clinical strategies as dictated by evidence-based criteria, legislation and parity needs.
• Utilize Lean methodologies to identify process improvement and cultivate a culture of continuous improvement.
• Partner with Provider Network with strong knowledge of contracting process and effective strategies to promote BH outcomes, including performance metrics in furtherance of VBPs.
• Work closely with the BH Medical Director (via matrix reporting) to execute the vision and plans for BH services.

Supporting Responsibilities:

• Supports cost and utilization portfolio for BH within the assigned CCOs.
• Supports financial performance of innovative strategies and treatment models through strategic shared risk/reward contracts with key provider partners.
• Recommends budgets in alignment with short and long-term plans.
• Works with department leadership in responding to inquiries or complaints to the Oregon Health Authority or other regulatory agency, preparing reports for other review functions, and addressing grievances and appeals.
• Advises the Company regarding the appropriateness of reimbursement for services, considering diagnosis, and contract provisions.
• Coordinates business activities by maintaining collaborative partnerships with key departments.
• Meets department and company performance and attendance expectations.
• Follows the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Performs other duties as assigned.

SUCCESS PROFILE

Work Experience:

Minimum 5 years’ experience in a behavioral health or behavioral health plan setting required, including at least 3 years in people management and/or leadership positions. Demonstrated knowledge and experience with program development. Demonstrated execution of complicated initiatives in a matrixed environment. Experience working with Oregon Medicaid and/or OHP behavior health benefits preferred.

Education, Certificates, Licenses:

Advanced clinical degree in behavioral health (mental health and/or substance use disorders). Licensed Clinical psychologist, LCSW, LPC, LMFT, or comparable behavioral health professional with extensive experience preferred.

Knowledge:

Thorough knowledge and understanding of medical and behavioral procedures, diagnoses, treatment modalities, procedure codes, including ICD-9 & 10, DSM-5, ASAM-PPCR-5, HCPCS and CPT Codes, health insurance and mandated benefits (including those provided by a wide array of community partners) within Oregon and the Pacific Northwest. Thorough knowledge of community services, providers, vendors and facilities available to assist members. Ability to use computerized systems for data and document recording and retrieval. Maintain current clinical knowledge base. Proficient in the use and implementation of the following tools and concepts across all teams within scope of accountability: Strategy Deployment, Daily Operations, Visual Management, Operational Improvement, auditing.

Competencies:

Building Trust

Building a Successful Team

Aligning Performance for Success

Building Partnerships

Customer Focus

Continuous Improvement

Decision Making

Facilitating Change

Leveraging Diversity

Driving for Results

Autonomous accountable work

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 50% of the time within Oregon to local CCOs and associated communities.

Skills:

Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range:

$108,468.62 - $184,396.64

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.

• We are one team working toward a common goal.

• We are each responsible for customer service.

• We practice open communication at all levels of the company to foster individual, team and company growth.

• We actively participate in efforts to improve our many communities-internally and externally.

• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.