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Provide clinical leadership and oversight for behavioral health care management programs across adult and pediatric populations.
Ensure behavioral health interventions are evidence-based, measurement-driven (e.g., PHQ-9, GAD-7, PROMIS), and aligned with value-based care goals.
Serve as a subject matter expert for complex behavioral health cases, including severe mental illness, inpatient and post-acute behavioral health transitions, crisis intervention, and high-utilization members.
Partner with senior leadership to build & operationalize the CCM behavioral health strategy, specialty care pathways, and program enhancements.
Directly manage and develop a team of behavioral health clinicians, providing coaching, mentorship, and performance•management.
Foster psychological safety, clinical excellence, and accountability within a virtual care environment.
Lead onboarding, training, and ongoing clinical education to ensure consistency, quality, and confidence across the team.
Identify skill gaps and partner with leadership to design targeted training and upskilling initiatives.
Oversee day-to-day behavioral health operations, including workload distribution, caseload equity, staffing alignment, and workflow optimization.
Ensure timely access to care, appropriate triage, and escalation for high-risk behavioral health cases.
Collaborate cross-functionally with Utilization Management, Navigation, Product, Clinical Affairs, and Quality teams to ensure integrated, closed-loop care delivery.
Ensure adherence to clinical standards, regulatory requirements, and professional practice guidelines for behavioral health care.
Monitor quality metrics, audit results, and client performance indicators; lead corrective actions and continuous improvement initiatives.
Partner with Quality and Compliance teams to mitigate clinical risk and support audit readiness.
Data, Reporting & Performance Optimization
Track and analyze behavioral health performance metrics, including engagement, outcomes, utilization impact, and quality scores.
Use data to inform staffing decisions, workflow refinements, and care model enhancements.
Prepare and present performance insights to senior leadership and client stakeholders as needed.
Nurse Practitioner (NP) or Master of Science in Nursing (MSN) from an accredited nursing program.
Active, unrestricted RN license in at least one U.S. state (multi-state licensure preferred).
Minimum 5 years of clinical experience in behavioral health, including experience with complex, high-acuity populations.
Minimum 3 years of people-management experience leading clinical teams in healthcare settings.
Demonstrated expertise in behavioral health assessment, treatment planning, crisis management, and care coordination.
Experience working within virtual, telehealth, or population health models strongly preferred.
Strong data literacy with the ability to interpret performance metrics and translate insights into action.
Excellent communication, leadership presence, and relationship-building skills.
Ability to lead through change, balance competing priorities, and operate effectively in a fast-paced environment.
Experience in value-based care, population health, or complex care management programs.
Prior leadership experience overseeing interdisciplinary or specialty behavioral health teams.
Familiarity with NCQA, ACMA, or other relevant accreditation standards.
Experience partnering with Utilization Management, payer organizations, or external behavioral health providers.
Ability to work in a primarily sedentary, computer-based environment.
Manual dexterity to operate standard office and virtual care equipment.
Occasional lifting up to 20 lbs (e.g., laptop or office equipment).
Occasional overnight business travel may be required.
Ability to engage professionally with leadership, peers, and members in a virtual setting.
Originally posted on Himalayas