Program Manager, Consultant (Mental Health Parity Addiction Equity Act)

About the position

The Program Manager, Consultant for the Mental Health Parity Addiction Equity Act at Blue Shield of California is responsible for overseeing the Utilization Management team's compliance with federal and California state mental health parity requirements. This role involves providing leadership and guidance for the Mental Health Parity program, ensuring adherence to regulations, and managing vendor contracts related to clinical guidelines and training. The position requires strong analytical and communication skills to effectively interact with various stakeholders and present findings to the Utilization Management Committee.

Responsibilities
?? Provide overall program leadership, guidance, and management of all aspects of the Utilization Management Mental Health Parity program.
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?? Oversee the Utilization Management organization's adherence to federal (CAA 203) and California (SB855) mental health parity mandates.
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?? Complete annual and off-cycle revisions to policies and procedures, desk level procedures, and provider manuals to align with regulatory requirements.
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?? Conduct annual evaluation of CAA 203 factors to validate the application of prior authorization and concurrent review.
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?? Develop and present quarterly Mental Health Parity reports to the Utilization Management Committee.
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?? Serve as the Utilization Management subject matter expert (SME) for mental health parity mandates and compliance.
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?? Manage multiple vendor contracts for nonprofit association clinical guidelines and training.
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?? Drive Utilization Management system enhancements to accommodate updated and/or new clinical guidelines.
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?? Represent Utilization Management during internal and external mental health parity related audits and requests.
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?? Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues.

Requirements
?? Requires a bachelor's degree or equivalent experience.
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?? Requires at least 7 years of prior relevant experience.
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?? Requires prior relevant experience in a managed care setting with knowledge of compliance and regulatory affairs.
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?? In-depth knowledge of federal (CAA 203) and California state (SB855) Mental Health Parity laws.
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?? Strong understanding of Behavioral Health Utilization Management.
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?? Strong analytical skills, including the ability to interpret and determine the impact of complex laws, regulations and other documents.
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?? The ability to independently achieve objectives and resolve issues under ambiguous circumstances.
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?? Strong decision-making, organizational, planning, and problem-solving skills.

Nice-to-haves
?? Strong presentation skills with the ability to tailor presentations to a specific audience, and address and interact with large groups preferred.

Benefits
?? Work from home

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