- Program and Project Management
- Utilize appropriate monthly and quarterly dashboards and reporting to assure regular monitoring of behavioral health performance. Work with Clinical, Quality, and NCQA compliance SMEs to ensure that program delivery is compliant with national guidelines and meets best practice standards for all state and federal regulations related to behavioral health utilization review, case management/Health Coordination, and quality improvement functions.
- Work with project teams to make mid-course corrections to assure measures achieve short- and long-term goals. Manage the concurrent timelines associated with multiple high-level, mission-critical, cross-departmental programs and projects. Work directly with cross-departmental team members to facilitate communication and provide status updates to the business owner, executive sponsor, and project team.
- Managing Project Teams for Behavioral Health
- Drive and direct project teams and subject matter experts through the planning, development, implementation and evaluation of clinical quality initiatives that achieve the optimal behavioral health quality goals. Provide clinical input and analyze measures to assist teams in identifying the most appropriate area(s) for interventions (provider, member, data, pharmacy). Integrate with HMSA departments and other partners' programs for optimal performance and improvement of measures. Assist in the development of requirements, reports, budgets, and other analyses, and help solve operational issues and roadblocks. Assist with operational aspects of the BH program, both of the BH vendor and internally. Act as a subject matter expert in matters related to compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) and participate as a key member of HMSA's cross-functional mental health parity team.
- Research and Analysis
- Gather and review information to identify trends and best practices to assist teams in developing robust interventions. Manage the development of strategies and tactics based on logical assumptions and facts considering resources, constraints, and HMSA values.
- Cross-Functional Integration and Communication
- Work with the Quality Improvement and vender management team, as well as other HMSA departments and external partners to monitor, collect, communicate, and distribute information to ensure coordination among organizations. Communicate analysis, assessments, recommendations and completed work product through professional written and oral reports and presentations. Oversee the delivery and execution of the contract as well as manage any changes to operations, monitor any interruptions to services, and make recommendations to improve operations to reduce risk to the program including updating any performance guarantees in vendor contract that align with performance expectations by HMSA's payors including employer groups, Med-QUEST, CMS, and Federal Employees Health Benefits Program.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
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HMSA
May 15, 2025