Director, Behavioral Health Operations

About the role

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at 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.

The Director, Behavioral Health Operations, is responsible for leading operational oversight and execution support for Mass General Brigham Health Plan's Behavioral Health vendor relationship and related business processes. This role serves as a key operational liaison among internal business owners, Clinical Behavioral Health, Product, IT, Customer Service, Provider Relations, Claims, Compliance, and external Behavioral Health vendors to ensure vendor operations are aligned with regulatory, contractual, benefit, claims, provider, and member experience requirements.

Responsibilities

• Lead operational oversight of Behavioral Health vendor administration, including coordination of business processes, issue resolution, implementation support, and ongoing monitoring of key operational deliverables.
• Serve as a primary operational liaison between MGB Health Plan and designated Behavioral Health vendors, currently Optum Behavioral Health, and any other Behavioral Health service vendors designated by the Chief Operating Officer.
• Partner with Clinical Behavioral Health, Product, IT, Claims, Customer Service, Provider Relations, Compliance, and line-of-business leaders to ensure vendor operations support Medicaid, Medicare Advantage, Commercial, and other applicable business requirements.
• Monitor operational compliance with federal and state regulatory requirements, contractual obligations, benefit coverage requirements, provider payment expectations, member cost-sharing rules, and related operational standards.
• Support Mental Health Parity compliance activities, including participation in the Mental Health Parity Committee, coordination of operational inputs, issue follow-up, and alignment of Behavioral Health vendor operations with parity-related requirements and action plans.
• Coordinate with IT application business owners (e.g., QNXT, Epic, etc.) and other system stakeholders to support appropriate application of business rules across internal and vendor systems.
• Support escalated member, provider, broker, and customer service issues by providing operational analysis, expected claims or benefit outcome guidance, and coordination of appropriate remediation steps.
• Identify, track, and escalate operational risks, defects, trends, and recurring issues related to Behavioral Health vendor operations, claims processing, benefit implementation, provider payment, member experience, and operational handoffs.
• Review operational outputs from delegated vendors, conduct ad hoc analysis to validate performance, identify trends or deficiencies, and oversee development, execution, and follow-through of corrective action plans, including review of claims processing adjustments to confirm accuracy, root cause, member or provider impact, and completion of remediation steps.
• Develop and maintain documentation of key Behavioral Health operational processes, decision points, issue logs, action plans, vendor commitments, and business requirements.
• Coordinate cross-functional workgroups as needed to address member, provider, broker, employer, or internal stakeholder friction points related to Behavioral Health operations.
• Support continuous improvement by identifying process gaps, recommending workflow improvements, and helping implement operational controls that improve quality, consistency, accountability, and transparency.
• Prepare and present concise updates, issue summaries, recommendations, and decision materials for executive and operational leadership.

Requirements

• Bachelor's Degree in a related field of study required; Master's Degree preferred.
• 8-10+ years of healthcare administration, business administration, public health, or health insurance experience required.
• At least 5-7 years of experience leading cross-functional operational work, vendor oversight, program execution, or complex healthcare operations preferred.
• At least 5-7 years of experience working with Behavioral Health operations, managed care vendors, claims processing, benefit implementation, regulatory requirements, and member or provider issue resolution preferred.

Skills

• Proven track record of effective change management, including but not limited to agile, waterfall, and hybrid project management, navigating organizational norms and business processes across institutions.

Schedule

• Monday-Friday role with standard business hours (Eastern time).
• Scheduled weekly hours: 40.

Pay

Pay range: $124,342.40 - $180,897.60 annually (Grade 9).

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your professional growth.

Benefits

• Competitive salaries.
• Comprehensive benefits package.
• Flexible work options.
• Career growth opportunities.

Working Conditions

• This is a remote role that can be done from most US states with a strong preference for local candidates who could attend occasional in-person meetings.
• Hybrid work location: 399 Revolution Drive.
• Employee type: Regular.
• Work shift: Day (United States of America).