Job Description:

Clinical & Strategic Leadership

• 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.

People Management & Team Development

• 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.

Operational Management

• 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.

Quality, Compliance & Risk Management

• 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.

Requirements:

Required Qualifications

• Master's Degree/PhD in relevant field (e.g MSW, MSN)

• 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.
  
  

Preferred Qualifications

• 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).

• 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.

Physical/Cognitive Requirements:

Physical & Cognitive Requirements

• 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.

114330 - 164640 USD a year