VP Behavioral Health and CISC

Location Address

• 9521 San Mateo NE Albuquerque, NM 87113-2237
• Summary
• Serves as the primary liaison to key behavioral health and children’s system of care stakeholders, including providers, associations, and government agencies.
• Acts as the external leader with state agencies such as the Behavioral Health Services Division of HCA, Department of Health, Children, Youth and Families Department, Agency on Aging and Long-Term Services Department, and the co-neutrals for the Kevin S. class action lawsuit.
• Oversees the Children in State Custody Program, ensuring all contractual and court-mandated directives are integrated and met.
• Develops and implements strategies for the behavioral health crisis continuum, collaborating with the PHS enterprise and stakeholder groups.
• Provides oversight of PHP’s behavioral health vendor/operations, ensuring network adequacy, responsiveness, and high clinical and operational performance.
• Directs the management and development of the statewide behavioral health and chemical dependency network and benefit management.
• Ensures clinical quality, financial performance, and member satisfaction goals are achieved.
• Collaborates with the VP, Population Health & Quality, and the Chief Medical Officer to advance integrated models of care for all business lines.
• Work Arrangement
• Remote: Open to U. S. applicants (excluding CA, IL, ND, NY, OH, WA, and WY).
• Hybrid: Required for those within 60 miles of a PHS location in New Mexico.

Responsibilities

• Lead and align BH activities across markets and products.
• Develop, execute, and assess strategic initiatives.
• Oversee contract negotiations and vendor relationships.
• Manage quality, compliance, and reporting for BH and CISC programs.
• Analyze trends, resolve member issues, and advise on provider network.
• Develop outreach strategies and integrate stakeholder engagement.
• Advance population health and health equity initiatives.
• Ensure regulatory compliance, accreditation, and policy development.
• Promote staff development and succession planning.
• Responsible for BH activities across all markets and products and work collaboratively with other areas to align strategic position across the organization.
• Develop and execute new strategic BH initiatives, with BH subcontractor where appropriate, and designed to support corporate goals including strategic operating priorities.
• Assess BH strategic needs based on the environment and Plan priorities; plan for new programs, products and business models, in collaboration with subcontractor as appropriate.
• Leads contract negotiations for Behavioral Health related areas in conjunction with, but not limited to, other areas represented by Chief Financial Officer, Chief Legal Officer, Chief Operating Officer or Chief Medical Officer.
• Provide clinical and administrative oversight of BH vendors.
• Provide oversight for the BH quality components.
• Provide strategic guidance on complex member issue resolution impacting Plan business.
• Analyze data from multiple sources to identify and respond to trends and / or emerging issues.
• Provide input as needed on provider credentialing, profiling and network development.
• Accountable for the compliant operation of PHPs Children in State Custody program, managing reputational risk for the Presbyterian organization.
• Develops methods and processes to ensure compliance with CISC and BH contractual requirements.
• Develops and maintains active outreach and engagement strategy with key children’s system of care, behavioral health, and community based organizations stakeholders.
• Ensures collaboration and integration of these efforts with other PHP stakeholder engagement efforts including advisory boards, committees, and events.
• Identifies opportunities and risks related to CISC and behavioral health priorities and develops and leads responsive efforts.
• Accountable for oversight of the activities and performance of PHPs behavioral health partner and ensures strong integration of clinical services in support of person‑centered care and leads efforts to integrate behavioral health into PHPs systems, with providers, across the PHS enterprise and with stakeholders in all lines of business.
• Ensures the behavioral health partner is providing contracted level of service including staffing, access to national resources, and performance.
• Organizes, implements and leads applicable Joint Operating Committee(s) for BH and related key vendors and ensures appropriate operational representation and participation.
• Provides effective representation for PHP to key stakeholders including serving as the primary point of contact for matters related to the Kevin S. Settlement agreement.
• Leads implementation efforts for behavioral health initiatives including the crisis continuum, and key clinical initiatives in accordance with governmental program requirements.
• Provides strong representation and collaboration to advance population health and health equity efforts.
• Works collaboratively with product leads in Medicare, Commercial, and Medicaid product lines to ensure optimal design and administration of Behavioral Health benefits in each product.

Views and treats product leads as "key customers." Accountable for behavioral health reporting for all lines of business including HCA and employer groups.

• Maintains compliance of the behavioral health system with all appropriate state and federal psychiatric regulations, codes, contractual requirements, and state laws.
• Creates and implements a workplan for successfully maintaining NCQA accreditation.
• Develop, maintain, and promote staff performance, training, and provide a management succession plan.
• Provides supervision and/or support for all Behavioral Health Department functions.
• Meets and/or exceeds quality targets.
• Required Qualifications
• Master’s Degree in a Behavioral Health Discipline or the equivalent combination of training and experience is required.
• 5 years of experience with managing behavioral health operations; such experience in a managed care setting preferred.
• Demonstrated effectiveness in external‑facing leadership roles. Excellent communications and interpersonal skills required.

Benefits

• Competitive salaries
• Full medical, dental and vision insurance
• Flexible spending accounts (FSAs)
• Free wellness programs
• Paid time off (PTO)
• Retirement plans, including matching employer contributions
• Continuing education and career development opportunities
• Life insurance and short/long term disability programs

AA/EOE/VET/DISABLED. PHS is a drug‑free and tobacco‑free employer with smoke free campuses.

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