Behavioral Health Program Manager

Apply now

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

At the direction of the Manager of Behavioral Health Operations, the Behavioral Health (BH) Program Manager, New Hampshire (NH) is responsible for leading and resolving high visibility behavioral health (BH) initiatives, issues and priorities through significant interface with the health plan’s material subcontractor.  Key deliverables include the oversight of New Hampshire reporting and facilitation of the completion of key contractual components of the Plan’s Behavioral Health Program. This person is responsible for: collecting and analyzing New Hampshire management and regulatory reporting data and oversight activities as well as establishing and maintaining structures and processes to support BH contractual operational initiatives, to include working with the appropriate staff at all levels throughout the organization to ensure the success of BH related projects or programs and compliance with all regulatory contractual standards.

Our Investment in You:

•        Full-time remote work
•        Competitive salaries
•        Excellent benefits

Key Functions/Responsibilities:

•        Key liaison for BH operational oversight of NH Medicaid, Medicare and ACA products, attending DHHS meetings as appropriate

•        Monitors and tracks priorities, using project plans and process improvement timelines as appropriate, serving as program lead as needed within cross-departmental initiatives to ensure that all issues are resolved and contractual deliverables are completed and submitted according to DHHS, CMS and WSHP corporate priorities.

•        Accountable for tracking, analyzing, responding to New Hampshire specific BH regulatory reporting, inclusive of necessary corrective action plans when reporting performance and/or contractually defined reporting standards are not met.

•        When performance and / or contractually defined standards are not met, determines opportunities for improvement and / or intervention, to include performance improvement plans and corrective actions; monitors and evaluates performance to completion of identified plan.

•        Supports the annual assessment and facilitation of the successful reconciliation of applicable contractual performance standards, specific to the New Hampshire products.

•        Responsible for leading and managing large multidisciplinary project teams and smaller sub teams around identified interventions to support identified health plan goals and priorities. 

•        Supports specific BH departmental activities as assigned by Director of BH Programs and Strategy, ensuring that BH deliverables meet regulator and internal timelines and content standards as defined and coordinating efforts as appropriate.

•        Evaluates progress toward meeting BH departmental and organizational goals, offers solutions to barriers, identifies, and escalates risks.  Communicates findings to all levels of the organization.

•        Supports departmental strategic efforts by managing and implementing operational aspects of identified strategic initiatives

•        Works with business intelligence and corporate analytics to ensure that data needs are identified and incorporated in any identified interventions

•        Supports NH BH Quality work including member discharge outreach activities through monitoring of ADT feeds between the Plan and the BH Vendor and oversight of regulatory reporting

•        Prepares documentation and timely summaries of work to support external quality review activities for assigned contractual obligations, which may include contract oversight tracking mechanisms in preparation for annual regulatory audits, and is able to respond to regulatory inquiries as required

•        Creates standard operating procedures to support behavioral health programmatic initiatives and collaborates cross-functionally on streamlining processes within business areas

•        Conducts oversight of overarching programmatic responsibilities, such as contracting, credentialing

•        Other functions as required to support departmental activities, to include overall day to day resolution of BH operational issues, as appropriate and assigned.

•        Regular and reliable attendance is an essential function of the position.

Qualifications: 

Education Required:  

·        Bachelor’s Degree or the equivalent combination of training and experience in Health Care / Behavioral Health / Public Health or related field, plus 3 years managed care related experience.

Education Preferred:

·        Master’s Degree

Experience Required: 

·         3+ years’ behavioral health/ healthcare/ managed care experience

Experience Preferred/Desirable:

·        Program, Project or Account Management experience

·        Experience with Medicaid, Medicare recipients and community services.

·        Prior Behavioral Health Management experience preferred.

·        Experience with provider or government relations preferred

·        Prior experience interpreting contractual expectations

·        Experience in project development, management and / or health policy.

Competencies, Skills, and Attributes: 

·        Excellent interpersonal skills and communication skills to succeed in a cross-functional, matrixed environment required.

·        Process-oriented  with strong organizational and time management skills with the ability to prioritize competing priorities, meet deadlines, coordinate with others to accomplish general objectives, problem solve and influence outcomes

·        Flexible, independent, self-starter with an ability to thrive in a fast paced environment

·        Ability to receive, comprehend and use logical reasoning for simple and complex problem solving

·        Capable of supporting multiple tasks needed, with proven ability to take ownership of project and responsibilities under minimal supervision

·        Strong collaboration across internal and external teams and leadership

·        Analytical and reporting skills required

·        Effectively manages difficult group dynamics to reach a positive outcome.

·         Knowledge of Healthcare/Health plan operations required

·        Strong understanding of HIPAA Guidelines.

·        Strong working knowledge of regulatory and accreditation agency standards

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

Apply now