MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Under the supervision of the Vice President of Behavioral Health, the Senior Director of Behavioral Health (BH) Strategy is responsible for the implementation and oversight of behavioral health clinical, provider, quality, and operational strategic initiatives, and department workflows to enhance department outcomes. The Senior Director of BH Strategy is a key stakeholder of State and Federal initiatives that impact BH operations and clinical programming such as the 1115i waiver, Center of Excellence quality initiative, and POP performance.

Responsibilities for this position include management and/or oversight of key performance improvement projects that impact the department's outcomes and compliance with local, Federal, and State regulations and guidelines. The Senior Director of BH Strategy drives operational excellence for the department.

• Key stakeholder in the development and design of department strategic initiatives to ensure operational, quality, and clinical excellence.
• Responsible for implementation and execution of New York State 1115i behavioral health programs in collaboration with cross-functional teams.
• Participate in the development and execution of innovative BH provider payment models and monitor impact on member outcomes and fiscal impact.
• Responsible for development of key clinical outcome metrics for care management reporting such as gaps in care and engagement in BH, primary care, and non-medical community-based services.
• Execute department responsibilities on projects and initiatives to strengthen behavioral health operations and claims performance and enhance network access monitoring.
• Responsible for budget oversight and reporting on NYS agency initiatives, provider-funded projects, and models of care.
• Responsible for providing subject matter content for vendor contracts and monitoring of SLAs that impact the BH department outcomes.
• Responsible for adult and child behavioral health provider engagement and growth to enhance access and provider satisfaction.
• Provide behavioral health subject matter expertise in project management, project scope definition, risk identification, project methodology, and resource.
• Continuous market analysis of available clinical tools for enhanced member outcomes.
• Key stakeholder on member retention analysis and improvement initiatives.
• Drives operational efficiencies and continuous improvement in department programs.
• Drives process and programming for social determinant of health screenings and planned programmatic interventions.
• Supports clinical, quality, cost management, reporting, and strategic initiatives and provides project management, as necessary.
• Ensures compliance with Federal, State and City regulations as they relate to Behavioral Health
• Builds alliances with other departments responsible for functional aspects of the BH/HARP including but not limited to Quality Management, Utilization Management, Case Management, Sales, Eligibility, Core System Operations, Provider Network Operations, Member Services/Experience Services, Claims, Analytics & Reporting, and Finance to ensure collaboration, efficiency, issue resolution and operational excellence.
• Responsible for development of executive reporting and presentations.
• Represents the health plan and BH/HARP Department at various meetings as required
• Provide analytics as needed to support BH reporting
• Participate in the Plan's Claims/UM/CM/DM system migration and updates as needed.
• All other tasks and projects as assigned

• Master's degree or higher required
• Minimum (10) ten years of progressively responsible experience in behavioral health program oversight, strategy, quality, or operations
• Minimum (5) years of managed care supervisory experience required.
• Project management experience required.
• Expertise in the NY BH delivery system of care
• Experienced in qualitative, quantitative, and healthcare analytics for measuring priorities and performance
• Experience in risk attribution and prevention-based models of care
• Experience in managing information systems
• Experience in leading and implementing strategic projects
• Experience in behavioral health payment models preferred.

Licensure and/or Certification Required

• LMSW, LCSW, LMHC or Licensed Psychologist required

Professional Competencies

• Integrity and Trust
• Customer Focus
• Strategic Planning
• Functional/Technical Skills
• Written/Oral Communications
• Strong problem solving, analytical and critical thinking skills
• Strong ability to anticipate needs and proactively address issues
• Work within timeframes, available resources, and with ever shifting priorities
• Demonstrated leadership skills
• Always provides excellent customer service, to internal and external customers.

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