Director Behavioral Health

Lets do great things together!

About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.

Please fill out an application on our company page linked below to be considered for this position.
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Required Skills Experience & Education:

• Current unrestricted Oregon license as mental health professional (e.g. Registered Nurse Psychiatric Mental Health Nurse Practitioner Licensed Psychologist Licensed Clinical Social Worker Licensed Professional Counselor Licensed Marriage and Family Therapist).
• At least ten years experience in behavioral health treatment and/or health plan setting including five years in a supervisory or management position.
• Excellent verbal written and interpersonal communication skills including ability to tailor presentations to varying audiences.
• Proficiency with Microsoft Word Excel and typing. Familiarity with case management database software preferred.
• Knowledge of regulatory environment including Mental Health Parity.
• Knowledge of Utilization Management standards and practices.
• Sound clinical and practical judgment.
• Ability to utilize a systems framework in analyzing and solving problems.
• Ability to foster a healthy and productive work environment for employees.
• Ability to work overtime as necessary.

Primary Functions:

• Recommends strategic direction for Modas BH program to senior leadership; anticipates emerging trends market demands and opportunities.
• Leads development of new programs and ensures successful of initiatives.
• Ensures department standards goals objectives and results are achieved by training delegating coaching monitoring documentation maintaining accurate records and tracking outcomes.
• Establishes effective collaborative working relationships with other departments such as Customer Service Medical Professional Relations Marketing Claims and Compliance where there is shared procedural/policy interest.
• Develops and maintains relationships with external stakeholders including providers state agencies legislators and work groups employer groups and community groups.
• Oversees contracting and relationships with BH vendors.
• Serves as Behavioral Health subject matter expert in managing the client interface across all lines of business
• Provides subject matter expertise to Modas legislative committee; recommends positions on BHrelated bills affecting Modas business; provides testimony to legislative committees and rulemaking advisory committees; provides information and analysis to Modas lobbyists and government relations teams.
• Advises and collaborates with Regulatory team regarding behavioral health benefits and regulatory issues. Provides key content and analysis for annual Mental Health Parity compliance reviews and submissions.
• Advises and coordinates with Medical Contracting and Medical Professional Relations teams regarding contracting activities and relations with behavioral health providers and facilities.
• Provides direction for valuebased reimbursement initiatives related to behavioral health.
• Supervises Psychiatric Medical Consultants BH Clinical Liaison and BH Manager providing guidance and mentorship monitoring program performance giving performance reviews.
• Provides leadership for development organization and implementation of behavioral health medical necessity criteria.
• Provides backup to BH Manager in completing BH authorizations for Moda Health employees.
• Reviews and authorizes the planning development organization and implementation of BH protocols policies and procedures and Quality Improvement Projects (QIPs).
• Ensures accuracy and timeliness of BH of the monthly Medical Management reports to internal and external customers.
• Coordinates with other department directors to provide leadership for departmental efforts related to IT programs and needs.
• Oversees system for maintaining and upgrading configuration of departments clinical database program (CT Dynamo).
• Performs other duties as assigned.

• Office environment with extensive close PC and keyboard work constant sitting and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week including evenings and occasional weekends to meet business need.
• Internally with all departments. Externally with providers Oregon Health Authority Department of Consumer and Business Services legislators vendors members brokers employer groups.

Together we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.

For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.