Associate Clinical Director Mental Health

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Job Profile: Associate Clinical Director, Behavioral Health
Job Code: HCM295
Grade Level: H
Business Title: Associate Clinical Director Mental Health
Reports To: Vice President of Clinical Operations
The Role
The Associate Clinical Director of Mental Health is responsible for all case management and utilization management/clinical review processes and clinical strategies required to support and implement HMM’s clinical strategy. This role is a trusted partner to the Sr. Medical Director of Mental Health, the Associate Director of Mental Health Strategy, and the Sr. Clinical Directors of all product and service lines.
The Associate Clinical Director of Mental Health collaborates and drives alignment across enterprise mental health support teams to identify clinical improvements and solutions to support our member’s experience accessing appropriate mental health services. This role oversees all decisions related to budget, resource planning, hiring and performance management of the Mental Health Case Management and Utilization Management teams—approximately thirty-five clinical full-time employees in total.
The Team
This role drives clinical workstreams, and supports communication through various channels (e.g., accounts and account assessments, Systems and Reporting, Medical Cost Council, Quality and Compliance, Payment Policy, Claims and external business teams). As an integral part of the HMM leadership team, the Associate Clinical Director of Mental Health works with partners in Business Operations and Strategy to ensure alignment, tracking, continuous improvement, and success of key performance metrics, objectives, and key results.

Key Responsibilities:
Lead the teams supporting case management and utilization review (prior authorization) of mental health and serve as a consultant to the buy up programs, Federal Employee Program and Medicare lines of business.
Initiate and lead change throughout the HMM clinical support organization with emphasis on cross-training associates, supporting members longitudinally, and removing barriers to care.
Serve as clinical lead for implementation of projects prioritized by the Strategy Committee or in support of Business Operations.
Define and spearhead implementation of solutions to support mental health strategy, engaging appropriate Case Management and Utilization Management resource teams, including refining documentation requirements and standards while still meeting any regulatory requirement.
Responsible to address day to day clinical management issues that need immediate attention, always with an eye to long-term development, including continually assessing clinicians’ skill sets and cross-training to ensure adequate coverage for all services.
Engage Blue Cross Blue Shield of Massachusetts business leaders on key areas of the business to forge relationships and understand the challenges and strategic goals that the clinical team supports.
Facilitate clinical leadership development opportunities for Case Management and Utilization Management teams and encourages participation of teams in clinical learning opportunities.
Manage and monitor key deliverables related to productivity, account performance guarantees and compliance requirements.
Interact closely with Business Operations leaders to carry out key projects and work with other senior leaders to drive successful completion of clinical initiatives.
Advise and make recommendations to clinical leaders on key strategic, technical, and tactical decisions related to program design.
Drive a cohesive approach aligning change management activities, including communications planning, training, and stakeholder management.
Develop key metrics—including objectives and key results— defining current state, future state and monitoring of trends for continuous improvement.
Share data with managers and associates as appropriate for improvement of workflows.
Perform senior-level strategic, qualitative and quantitative analysis of program and project management tasks for the department using research, data, and analytics to resolve highly complex issues that require significant probing, analysis, and interpretation.
Serve as a member of the Non-Quantitative Treatment Limitation Committee, supporting the analysis and documentation of mental health workflows and policies.
Responsible to leader and to matrixed relationships for work performed cross-functionally.

Key Qualifications:
Ability to lead in a clinical operations environment and manage clinical staffing needs, including developing, and monitoring team and individual metrics, creating and utilizing reports to measure cost, quality, and productivity, and identifying and implementing workflows and process improvements.
Experience managing and coaching others, as well as strong team building, consensus-building, and negotiating skills.
Demonstrated ability to handle multiple priorities in a fast-paced environment.
Ability to use data to identify operational improvement opportunities, quickly pilot changes and assess impact.
Excellent communication skills, verbal, written, and presentation, including the ability to communicate appropriately across all levels of an organization.
Demonstrated ability to interface with physicians, nurse reviewers and other management and administrative staff at all levels of the organization.
Demonstrated initiative to identify opportunities for improvement and recommend and implement innovative solutions.
Strong understanding of HMO, PPO and payer-based products as well as consumer driven health plan models
Uses solid clinical and interpersonal skills to accomplish program or project goals through collaboration across areas with no direct reporting line.
Deep mental health clinical operations understanding.
Executive presence with the ability to partner with senior business leaders as a credible clinical spokesperson.
Ability to interact with associates at all levels of organization.
Ability to effectively plan and facilitate multi-disciplinary meetings and workgroups.
Demonstrated ability to lead, motivate and manage direct reports, cross-functional teams, and matrixed relationships.
Ability to foster a team environment committed to risk taking, change management, and creativity.

Education and Experience:
Clinical license and at least five years in clinical practice in field related to mental health .
Undergraduate Degree or master’s degree preferred or equivalent experience in healthcare field resulting in clinical license. Additional Business Administration education/experience a plus.
10+ years in healthcare with at least five years in an operations leadership role.

Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above

Location Quincy Time Type Full time

Salary Range: $135,630.00 - $165,770.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).