Sentara Health Plans is currently recruiting for an experienced, senior level
Director - Health Plans, Behavioral Health
Managed Care/Health Plan experience
Utilization Review and Case Management
Regulatory Agency Requirements experience
*Managed Care Leadership experience is strongly preferred*
Required Education: Minimum Bachelor's level degree in any of the following disciplines:
*Master's Level degree in any of the above fields is strongly preferred*
The Director of Behavioral Health is responsible for the strategic leadership of behavioral health and addiction recovery treatment services for the health plan. This includes program development, design, outcomes measurement, and evaluation of behavioral health programs for all lines of business. Leads the identification and initiation of process improvements and implementation of projects for new services, contract requirements, and regulatory requirements.
Stays abreast of NCQA, DMAS, and CMS policies and standards and oversees compliance with policies, programs, and service delivery. Partners with the Health Plan Quality Team to maximize HEDIS, CAHPS, and STARS ratings which integrate behavioral health services. Develops and monitors training for operational expansion and product development as it relates to behavioral health. Oversees root cause analysis and associated actions to improve clinical outcomes. Serves as the Behavioral Health representative to DMAS and other external stakeholders related to behavioral health initiatives.
Minimum 5 years of Behavioral Health Managed Care Operational leadership experience
Minimum 3 years Home Care Management and Regulatory Agency requirements experience
Internal Number: 139972
About Sentara Healthcare
For more than a decade, Modern Healthcare magazine has ranked Sentara as one of the nation's top integrated healthcare systems. Our not-for-profit system proudly includes 12 hospitals in Virginia and Northeastern North Carolina, including a Level I trauma center, the Sentara Heart Hospital and the Sentara Healthcare Cardiovascular Research Institute, the Sentara Brock Cancer Center and the accredited Sentara Cancer Network, two orthopedic hospitals, and the Sentara Neurosciences Institute.
The Sentara family also includes four medical groups, Nightingale Regional Air Ambulance and ground medical transport, home care and hospice, ambulatory outpatient campuses, advanced imaging and diagnostic centers, a clinically integrated network, the Sentara College of Health Sciences and the Optima Health Plan and Virginia Premier Health Plan serving 858,000 members in Virginia, North Carolina and Ohio.
Among our many strengths, we are a national leader in heart and kidney care, stroke care, and infection prevention. We were also the first in the nation to pioneer and develop the eICU, a remote monitoring system for intensive care. Our dedication to improving and increasing medical option...s for our patients is reinforced by our ongoing participation in national and international research. These vital medical trials help us advance toward our mission of improving health every day.