EmblemHealth · 3 hours ago
Director of Behavioral Health Strategy & Operations
New York, United States
Full-time
Hybrid
Senior Level, Lead/Staff
$114K/yr - $210K/yr
10+ years expEmblemHealth is focused on enhancing behavioral health services and is seeking a Director of Behavioral Health Strategy & Operations. This role involves leading the development and execution of behavioral health strategies, optimizing processes, and collaborating with cross-functional teams to improve healthcare delivery and member satisfaction.
InsuranceNon ProfitWellness
Hiring Manager
Bridgete Nunes
Responsibilities
Develop and execute the enterprise behavioral health strategy across all lines of business (Medicare, Medicaid, Commercial)
Serve as operational lead in supervising Behavioral Health (BH) vendor, taking responsibility over Carelon and services provided by them to our members
Support integration between behavioral health and physical health to support whole-person care
Partner with internal operations, network, and analytics teams to design efficient workflows, reduce administrative burden, and enhance member outcomes
Oversee performance of internal and delegated behavioral health operations including care management, appeals/grievances, and quality reporting
Lead continuous improvement initiatives focused on access, timeliness, and member engagement
Monitor key performance indicators (PMPM cost, utilization, readmission rate, engagement rate) and drive accountability for results
Drive Performance improvement initiatives for access, quality and affordability
Monitor NYS-required settlement activities around service delivery and quality of patient satisfaction to ensure that providers in-network
Develop and lead behavioral health initiatives with leadership clinical and executive leadership
Support the innovation agenda for behavioral health, identifying and implementing emerging models of care, digital solutions, and community-based partnerships
Support the development of EmblemHealth’s Behavioral Health member journey, optimizing access and member satisfaction. Develop complaint processes for members and providers with appropriate monitoring and mitigation of any ongoing issues
Determine and manage the effectiveness of EmblemHealth’s behavioral health provider directory, maintaining the effectiveness of response to continual service evaluation
Direct provider manual adjustments and updates as well as member-facing content adjustments
Define key evaluation metrics for behavioral health program and manage outcomes across teams
Provide Behavioral Health thought leadership to plan and external stakeholders
Collaborate with Provider Network Management & Quality Management to design and operationalize new value-based model(s) with network providers
Manage & participate in various provider-facing Joint Operating Committee meetings with BH providers
Represent behavioral health externally and in appropriate regulatory meetings
Participate in behavioral health committees as well as participate in various cross functional committees
Establish and maintain continuity in the planning, development and implementation of policies, operational processes, workflows required to execute organizational strategies and to assure consistency in process application throughout Care Management
Validate and monitor adherence to implemented policies, procedures, workflows and processes: identify, recommend and implement improvement initiatives accordingly
Qualification
Required
Bachelor's degree required; graduate degree in related field preferred
10 – 12+ years of relevant, professional work experience, including 5+ years in the healthcare insurance industry
Excellent understanding of Behavioral Health clinical & operations and business needs
Experience with project leadership and management, including planning, execution, and monitoring projects
Strong communication skills (verbal, written, interpersonal) to collaborate effectively with cross-functional teams and stakeholders; ability to drive collaboration and foster highly productive, functional relationships
Demonstrated agility and ability to drive program completion in expedited timelines
Excellent analytical and problem-solving skills, with the ability to interpret data and make data-driven decisions
Proven experience in leading process improvement initiatives and driving change within a healthcare organization
Ability to adapt to a fast-paced and evolving healthcare environment
Preferred
graduate degree in related field preferred
Company
EmblemHealth
EmblemHealth is an insurance and wellness company that offers health benefits to consumers, employers, and government purchasers.
1001-5000 employees
H1B Sponsorship
EmblemHealth has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
2023 (2)
2021 (2)
2020 (4)
Funding
Current Stage
Late StageLeadership Team
M
Michael Collins
Vice President CRM Applications
Recent News
Behavioral Health Business
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2025-12-06
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