Sr. Director, Behavioral Health Operations and Oversight

Company: Blue Shield of California
Location: El Dorado Hills
Posted on: May 7, 2025

Job Description:

Your Role The Senior Director, Behavioral Health Operations Oversight ensures behavioral health program integrity and compliance with state and federal regulatory standards and accreditation standards. This position works closely with management and employees to facilitate compliance with applicable federal and state regulatory requirements.Your Work In this role, you will:

• Serve as business driver for enterprise-wide behavioral health mandate implementations
• Direct behavioral health projects, initiatives, executive-sponsored initiatives, responses to regulatory audits, accreditations, on-site reviews, risk assessments to support behavioral health compliance
• Oversee all behavioral health compliance committees for all lines of business
• Lead internal monitoring to identify behavioral health process gaps, validate behavioral health operational compliance levels, map processes, draft corrective actions/remediation plans, oversee implementation of corrective actions, prepare reports/presentations
• Develop strategic plans, makes recommendations to leadership; designs/implements annual clinical operations compliance plan
• Develop strong relationships with key leaders to identify and address regulatory risks and failures. Accountable for action plans designed to fully mitigate risk(s)
• Review and analyzes regulations to determine the impact on plan behavioral health operations and identifies the need for new or revised policies, procedures, plan documents.
• Design behavioral health regulatory compliance training and materials; Reviews and develops policies and procedures from compliance perspective and maintains annual review and management of policies and procedures.
• In collaboration with compliance and regulatory affairs teams, prepares communications and reporting with the regulatory agencies such as DMHC filing submissions, regulatory reporting, and ad-hoc requests.
• In collaboration with compliance and regulatory affairs teams, prepares routine regulatory reports and analysis to include, but not limited to, Department of Health Care Services (DHCS); Department of Managed Health Care (DMHC); the California Department of Public Health (CDPH); California Department of Insurance (CDI) Centers for Medicare and Medicaid Services (CMS) Your Knowledge and Experience
  • Requires a Bachelor's degree, and a minimum of 12 years prior relevant experience in a managed care healthcare setting. Emphasis in behavioral health, preferred
  • Requires experience in California Compliance, HIPAA/Privacy, FWA and/or Regulatory Affairs operations preferred, including 6 years of management experience
  • Certificate of Healthcare Compliance (CHC) preferred
  • Requires in-depth knowledge of quality and change management process
  • Expert knowledge of state behavioral health regulatory requirements under the Centers for Medicare & Medicaid Services, Department of Managed Health Care and Department of Health Care Services
  • Strong analytical skills, including the ability to interpret and determine the impact of complex laws, regulations, and other documents
  • Knowledge of regulatory external audits, internal auditing and effective implementation, control, and monitoring processes
  • Strong interpersonal skills with the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside the Health Plan
  • Strong decision-making, organizational, planning, and problem-solving skills, and communication skills are needed to effectively interact with staff, team members and others in a professional and tactful manner
  • Strong presentation skills with the ability to tailor presentations to a specific audience, and address and interact with large groups

Keywords: Blue Shield of California, Sacramento , Sr. Director, Behavioral Health Operations and Oversight, Executive , El Dorado Hills, California