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Fallon Health Director, Behavioral Health Operations - Flexible Remote in Worcester, Massachusetts


Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022, all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org .

Job Summary:

The Director of Behavioral Health Operations leads business area transformation across BH leadership, vendor, and internal stakeholders. The Director is responsible for coordinating and driving overall BH deliverables and outcomes. The Director works to put in place processes, systems and cross-departmental collaboration to ensure all BH deliverables are advancing and being met. In addition, the Director supports the development and implementation of long-range strategic integration plans for the Behavioral Health Department in collaboration with the Sr Director of ACO and Behavioral Health Clinical Team.


Job Responsibilities:

Monitor ongoing Behavioral Health Vendor performance

  • Work closely with Medical Economics to understand utilization and MLR trends and identify areas of opportunity for improvement

  • Review and approve Behavioral Health reports produced by delegated entities and routinely report to the FH Delegation Oversight Committee on compliance to requirements and service standards according to the contractual agreement.

  • Collaborate with the Sr. Director of ACO and Behavioral Health Clinical Team and the Chief Medical Officer to establish Performance guarantees, and Performance Improvement initiatives and track outcomes

  • Communicate performance to senior leadership both internally and externally

Manage external relationships Behavioral Health Vendor and MassHealth

  • Provide supervision and oversight to Contract/Vendor Relationship Manager

  • Present to appropriate joint governance structures of Behavioral Health Vendor

  • Build and maintain positive relationships with both BH Vendor and State entities to ensure the organization can maximize the value of those relationships

  • Work quickly to address and resolve issues

Establish and maintain effective channels of communication

  • Proactively communicate with other departments and BH vendor to ensure cross-functional concerns are identified and effectively addressed.

  • Establish and maintain an open communication channel with staff.

  • Monitor effectiveness of communication with other groups (internal and external). Collaborates with Sr Director to implement changes as necessary to ensure an open, productive exchange of information.

  • Ensure correspondences between State agencies, the BH vendor and the Key Contact are being resolved in a timely fashion

Regulatory and contractual compliance

  • Proactively monitor NCQA, Medicare, MassHealth, Division of Insurance and Department of Mental Health to identify any changes in regulations, anticipate the effects these may have on Behavioral Health Programs, and help create strategies to prevent negative impact and promote change.

  • Ensure relevant changes to operations and/or contractual requirements can be supported.

  • Ensure operational compliance with all relevant regulatory agencies.

  • Ensure operations meet vendor/customer contractual requirements.

  • Keep abreast of changes in requirements.

  • Proactively identify areas of concern or exceptions and promptly notify stakeholders.

  • Reinforce product strategy with metrics, infrastructure, business processes, best practices, budgeting, and reporting

Oversee the internal operations for the BH team in partnership with the Sr Director of ACO and Behavioral Health Clinical Team

  • Oversee the management of the Behavioral Health Contract & Vendor Relations Manager and Behavioral Health Program Coordinator

  • Monitor workloads for staff within the department

  • Identify opportunities for growth and development

  • Develop goals and conduct performance reviews according to Fallon’s policies and procedures

Monitor market trends and identify behavioral health strategic growth opportunities for Fallon Health.

  • Monitor competitor products and strategies and identify threats and opportunities.

  • Prepare in-depth analyses of opportunities as it relates to BH innovations aligned with Commonwealth BH Strategic Roadmap.

  • Produce periodic assessments of the competitive environment.

  • Monitor regulatory developments and ensure Fallon’s products comply with state and federal requirements.

Develop planning and analysis for Behavioral Health Operations that support the strategic objectives of the larger organization, identifying short and longer-term requirements

  • Conduct/Oversee studies or analyses to determine feasibility and costs of initiatives.

  • Determine long-term resources (systems, skills needed, capacity planning, etc.) to meet future business needs.

  • Drive development of the cost/benefit analyses of operational changes in support of future business requirements.

  • Regularly analyze and report on the productivity and effectiveness of the operations in comparison to established performance metrics. Identify areas of improvement and recommend resolution.

  • Identify current and future product needs and impacts to internal operations, develop strong recommendations, and execute upon improved initiatives

  • Lead the development of innovations from conception through implementation

  • Monitor regulatory developments and ensure Fallon’s BH program complies with state and federal requirements.

  • Develop strong collaboration between all parts of the organization Behavioral Health Team Operations



BA/BS Degree in Business or Management, MBA or equivalent experience preferred.


Certified Project Manager preferred.

*Experience:  *

  • Minimum 5 years in a leadership role in product or business development in health care.

  • Previous experience in the sales, marketing, finance, actuarial, strategic planning, major project management or operations in a health plan and/or in management consulting.

  • Experience working in a behavioral health organization preferred

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Location US-MA-Worcester

Posted Date 1 month ago (5/24/2022 4:13 PM)

Job ID 6871

# Positions 1

Category Behavioral Health