This is a full-time (40 hour/week) remote role that requires an onsite presence at the office in Somerville when needed based on business needs.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

Mass General Brigham Health Plan provides for the delivery of behavioral health services to its members through a contracted relationship with United Behavioral Health (Optum), a managed behavioral healthcare organization. The Director of Behavioral Health provides oversight of its behavioral health vendor and is responsible for ensuring that services for Mass General Brigham Health Plan members are accessible, available, integrated, and coordinated with primary care. The Director of Behavioral Health works with internal and external stakeholders (i.e., Mass General Brigham, Commercial employer groups, EOHHS, MassHealth Office of Behavioral Health, CMS, and Trade Organizations) to ensure that the benefits and continuum of care meet the needs of the Mass General Brigham Health Plan's membership. The Behavioral Health Regulatory Program Manager assists and supports the Director in these and other regulatory activities.

The Regulatory Manager, Behavioral Health (BH) position will assist the Director of BH in the development and implementation of policies and procedures that measure the adherence of the health plan's BH clinical programs to key stakeholders, such as our key commercial accounts, as well as state and federal funding agencies responsible for funding and overseeing Medicaid and Medicare plans. This will include but is not limited to, setting up monitoring and adherence protocols that CMS requires for Medicare Advantage clinical programs, as well as identifying, developing, and executing all audit and mental health parity requirements as set for by the Executive Office of Health and Human Services for any Medicaid Accountable Care Organization.

The Regulatory Manager, BH will identify barriers and leverage strengths throughout the company to ensure the Mass General Brigham Health Plan BH clinical programs meet or exceed all state and federal requirements and will act as a subject matter expert on such topics as mental health parity, clinical audit programs, and the interpretation of rules and regulations both at the state and federal level. This person will collaborate with the legal, regulatory affairs and compliance department very closely to ensure the programs are socialized and vetted at the appropriate committees, including but limited to the Mass General Brigham Health Plan Audit and Compliance Committee, and Standards, Expectations and Compliance Committee.

Principal Duties and Responsibilities:

* Act as a subject matter expert in mental health parity, which will include, having a strong understanding of the current state and federal laws, as well as best practices that can address and close any mental health parity gaps.
* Provide expertise in the area mental health parity and provide language and/or operational recommendations that will reduce mental health parity and put MGB HP 'best in class' in this area. Ensure all program descriptions, presentations and evaluations sufficiently address mental health parity regulations and requirements.
* Provider leadership and consultation in mental health parity to colleagues, as well as key internal and external stakeholders at the state and federal level. Work closely with the legal, regulatory affairs, and compliance department to ensure all clinical programs are up to date and compliant with current regulations and laws.
* Maintain compliance with all BH utilization management and audit standards, including, but not limited, to the ongoing assessment of program performance against regulatory and business standards, and removal of barriers which may impede the plan's ability to meet those standards.
* Prepare for any site visits by state or federal agencies, which will include the compilation of materials, education to clinical staff, addressing any areas of non-compliance, and the solutions aimed at removing areas of oversight of any under or over utilization of services as well as expertise on the ways in which to adjust utilization of services to an accepted level.
* Responsibility for reporting to EOHHS, DOI, GIC and have materials prepared for the federal agencies, as requested.
* Participation in audits of ASO groups for Mass General Brigham.
* Responsibility also includes DOI mental health parity market conduct exams no less than every five years.
* Provide oversight of any under or over utilization of services as well as expertise on the ways in which to adjust utilization of services to an accepted level.
* Act as a subject matter expert to senior and executive staff in the areas of audit protocols and how they can be leveraged through the company to better understand and manage services.
* Coordinate required and ad hoc submissions to a wide vary of stakeholders, including but not limited to, the Executive Office of Health and Human Services, Massachusetts Department of Insurance, Center for Medicaid and Medicare Services, Massachusetts Association of Health Plans, the Massachusetts Center for Health Information and Analysis.
* Advising clinical leadership in operational changes and recommendations for change based on survey findings, regulatory or contractual change.
* Oversee audit protocols that assess the denial processes and practices and develop management and reporting tools that are helpful and impactful to the department.
* Oversee any BH utilization management or care management delegation agreements with outside providers, as well as internal stakeholders within Mass General Brigham. This will include coordinating with other areas within Clinical, such as quality management, and recommending practices that adhere to key programs such as National Committee for Quality Assurance health plan accreditation and health equity accreditation. Advise and recommend strategy, approach, and language regarding any delegation agreements with the MGB HP clinical program and other internal/external parties.
* Participate in the development of annual program goals and assess progress towards the achievement of the determined goals.
* Develop and maintain computer skills necessary to complete the assigned duties.
* Assist in the research, development, and design of educational materials.
* Manage, track and present progress and outcomes to senior leaders, as required, through formal presentations.
* Hold self and others accountable to meet commitments.
* Ensure diversity, equity, and inclusion are integrated as a guiding principle.
* Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
* Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
* Other duties as assigned with or without accommodation.
* Works well independently
* Builds strong customer relationships and delivers solutions that meet customer expectations
* Establishes and maintains effective customer relationships - both internal as well as external
* Hold self and others accountable to meet commitments.
* Ensure diversity, equity, and inclusion are integrated as a guiding principle.
* Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
* Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
* Other duties as assigned with or without accommodation.

Qualifications:

* Master's degree required or the equivalent combination of training and experience, plus 8-10 years of related experience in health care/managed care, Medicare Advantage experience, community health nursing, public health background.
* LICSW or LMHC preferred.
* Experience with NCQA, EQRO, CMS (including Medicare), and Massachusetts' State Regulations

Skills/Abilities/Competencies:

* Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
* Bring fresh ideas forward by listening to and working with employees and the people we serve.
* Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
* Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
* Strong aptitude for technology-based solutions.
* Ability to inject energy, when and where it's needed.
* Current in healthcare trends.
* Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."
* Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
* Excellent leadership skills and leadership track record.
* Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
* Ability to view the long-range trends and cycles of the business and industry and see the "big picture."
* Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
* Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
* Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
* Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
* Unquestionable integrity.

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.