Director, Behavioral Health, ASD and Member Services

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Job Title

Director, Behavioral Health, ASD and Member Services

Agency

Department of Community Health

Job Requisition ID

JR0000007915

Shift: Not Applicable (United States of America)

Compensation Details

$95,000 - $115,000

Job Description

Essential Duties and Responsibilities

Strategic leadership and policy. In coordination with the Executive Director of MAP, sets the vision, priorities and annual work plan for the Behavioral Health unit. Directs behavioral health policy, provider manuals, State Plan Amendments and waivers. Leads new initiatives such as Targeted Case Management, certified community behavioral health clinics (CCBHCs), crisis services, reentry and integrated care. Advises executive leadership on federal and state developments.

Parity compliance. Serves as the Department’s lead for mental health and substance use disorder parity under the federal Mental Health Parity and Addiction Equity Act and Georgia HB 1013. Directs annual reviews of the care management organizations (CMOs) and fee-for-service Medicaid and drives corrective action.

Program, benefit and ASD oversight. Oversee behavioral health and ASD benefit policy, prior authorization standards and provider requirements. Oversees relationships with residential and inpatient treatment settings, as well as out-of-state single case agreements and provider enrollment. Partners with program integrity on oversight of high-risk providers.

Managed care oversight. Serves as the primary behavioral health liaison to the Georgia Families CMOs. Provides SME reviews and feedback on CMO deliverables as required, recommends contract language and monitors performance. Recommends corrective action in partnership with CMO and Compliance leadership.

Grants, waivers and special projects. Assists, and, when necessary, leads the Department’s Medicaid health home initiatives involving behavioral health or foster youth. Serve as project director or business owner for federal and philanthropic grants, ensuring compliance, timely reporting and long-term sustainability.

Interagency and stakeholder leadership. Represents DCH with DBHDD, DFCS and other state partners, on statewide committees, and with providers, and advocates. Delivers briefings and presentations on behalf of the Department on as needed basis.

Member services.

Oversee behavioral health member services and the resolution of complex, cross-agency member cases, with a focus on children and youth with intensive Oversees behavioral health member services and the resolution of complex, cross-agency member cases, with a focus on children and youth with intensive needs.

When needed, provides direct one-on-one case management and family support for fee-for-service members in complex cases. Uses complaint trends to drive improvement.

Data, quality and accountability. Establishes key performance indicators and uses data to guide policy and program decisions. Ensures timely, accurate responses to CMS, auditors, the General Assembly and other oversight bodies.

Team leadership. Hires, develops, evaluates and mentors staff. Fosters a collaborative, accountable culture and supports succession planning and professional development for critical roles.

Preferred Qualifications

Master’s or doctoral degree in a behavioral health discipline, public health or public administration. A current, unrestricted Georgia behavioral health license (e. g., LCSW, LPC, LMFT, psychologist, PMHNP) is preferred.

Five or more years of Medicaid behavioral health policy or program experience, including managed care, and three or more years leading professional staff.

Experience with parity/NQTL analysis, State Plan Amendments or waivers, and federal grants or cooperative agreements, including Medicaid health homes.

Knowledge, Skills and Abilities

Expert knowledge of Medicaid behavioral health services, financing and federal authorities. This includes the State Plan, 1915(b), (c) and (i), section 1115, and managed care rules (42 CFR 438).

Knowledge of Georgia’s behavioral health system of care, plus a clinical background in behavioral health or intellectual and developmental disabilities.

Proven ability to lead change, use data to make decisions, and represent the agency credibly with senior officials and stakeholders.

Excellent written and oral communication, including presenting complex policy to non-specialist audiences.

Working Conditions

Hybrid schedule based in downtown Atlanta. In-person attendance is required for Board meetings and key stakeholder events. The role involves statewide travel, including occasional overnight travel, and occasional evening or weekend commitments. Subject to background, reference and credit checks.

Other Duties

This job description describes the general nature and level of work performed in this position. It is not intended to be an all-inclusive list of duties, responsibilities or qualifications. The incumbent will perform other related duties and special projects as assigned. Duties and responsibilities may change at any time, with or without notice, to meet the needs of the Department.

Minimum Qualifications

Bachelor's degree in operations management, business administration, or a related field which includes five (5) years in a managerial or supervisory role; or nine (9) years of related professional experience which includes five (5) years in a managerial or supervisory role; or five (5) years of experience required at the lower level Sr Mgr, Business Ops (GSM012) or position equivalent.--Note: An equivalent combination of knowledge, education, job or intern experience, training, or certifications that provides the necessary knowledge and skills to successfully perform the job at the level listed may be substituted year-over-year.

Equal Employment Opportunity Employer

The State of Georgia does not discriminate based on race, color, national origin, sex, religion, age, disability, or other protected categories in employment or the provision of services.

Qualified applicants may request reasonable accommodation when needed during the application and/or screening process by contacting the appropriate agency Human Resources department.