Senior Behavioral Health Program Manager, SHP

Job Description

The Sr. Behavioral Health Program Manager State Health Plan (SHP) owns the SHP Behavioral Health (BH) program portfolio including BH Utilization Management Case Management Care Navigation and the autism spectrum disorder (ASD) and Applied Behavior Analysis (ABA) program. The role integrates these into a single member-centered model translates SHP contractual commitments into sustainable operations and governance and partners across clinical enterprise compliance network and vendor teams to improve access maintain Mental Health Parity and Addiction Equity Act (MHPAEA) alignment and deliver measurable clinical member-experience and affordability outcomes.

What You Bring

• Program Ownership and Governance: Own the SHP BH portfolio and its multi-year roadmap aligned to SHP contractual commitments and BCBSNC strategy. Lead governance RAID management and leadership reporting; maintain SHP-specific BH policies and workflows across UM CM Navigation Appeals Claims and Customer Service; and lead implementation process improvement and change management through matrix teams.
• ASD/ABA Program Support: Support the integrated ABA UM and CM model with the BH clinical leaders and ABA staff and monitor ABA utilization spend and outcomes.
• Access Navigation and Integrated Care: Support BH navigation processes with closed-loop referrals across digital partners Customer Service and Care Management.
• Parity Compliance and Accreditation: Partner with Compliance Legal and enterprise MHPAEA experts on parity and NQTL analyses including the BH impact of medical/surgical designs such as tiering and gold carding. Lead audit readiness for NCQA NCDOI and federal and state requirements.
• Vendor Provider and Stakeholder Partnership: Represent BCBSNC with SHP consultants vendors and providers. Manage BH vendors and delegated entities through KPI monitoring operating reviews and corrective action and maintain clear escalation paths for issue resolution.
• Performance and Financial Stewardship: Define and track BH metrics for access utilization authorization timeliness ABA outcomes member experience and cost of care with the SHP Sr. Business Operations Advisor and analytics teams.
  

What You Bring

• Bachelors degree or advanced degree (where required)
• 5 years of experience in related field.
• In lieu of degree 7 years of experience in related field.

Bonus Points(Preferred Qualifications)

• Experience leading programs in behavioral health health plan operations care management or utilization management with demonstrated ownership of ongoing program performance.
• Working knowledge of ASD and ABA services MHPAEA and NQTL concepts NCQA standards and North Carolina regulatory requirements. Experience managing vendor or delegated-entity relationships including performance and service-level oversight.
• Strong skills in program governance risk and change management and cross-functional facilitation with the ability to translate complex information into clear recommendations for executive clinical and client audiences.
• Behavioral health clinical background or licensure (for example LCSW LCMHC LPA BCBA or RN with BH experience) and/or PMP certification is a plus.

What Youll Get

• The opportunity to work at the cutting edge of health care delivery with a team thats deeply invested in the community

• Work-life balance flexibility and the autonomy to do great work

• Medical dental and vision coverage along with numerous health and wellness programs

• Parental leave and support plus adoption and surrogacy assistance

• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

Where Youll Work

Our Hybrid-Flex approach is built on presence with a purpose giving you flexibility to work remotely with intentional in-person connection that supports a workplace thats flexible connected and future focused.

In a Hybrid-Flex role youll work in the office at least two days a week for collaboration and a Remote-Flex role youll work virtually with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid-Flex or Remote-Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training specialized skill sets licensure and certifications and other business and organizational base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus* 401(k) with employer match Paid Time Off (PTO) and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$89174.00 - $142679.00

Skills

Business Process Improvements Implementation Management Process Improvement Initiatives Process Improvements Project Management Project Management Oversight Project Performance Management (PM) Project Plan Development Resource Management Resource Planning

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