Senior Behavioral Health Program Manager

Blue Cross NC

. Own the SHP Behavioral Health program portfolio, including Utilization Management, Case Management, Care Navigation, and ASD/ABA programs .

Posted 10/28/2026full-timeDurham • North Carolina • United StatesSenior💰 $89,174 - $142,679 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing Behavioral Health programs, including Utilization Management and Case Management, while ensuring compliance with NCQA standards and North Carolina regulatory requirements. Proven ability to lead governance, process improvement, and vendor management to enhance member experience and operational efficiency.

Highest-signal resume keywords

Behavioral Health Program ManagementUtilization ManagementVendor Relationship ManagementProgram GovernanceChange Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementCase ManagementCare NavigationASD ServicesABA ServicesProgram GovernanceRisk ManagementPerformance OversightKPI MonitoringData Analysis

Soft Skills

Cross-Functional FacilitationClear CommunicationLeadership

Certifications & Qualifications

PMP Certification

Industry Keywords

MHPAEANQTLNCQA StandardsNorth Carolina Regulatory RequirementsBehavioral Health PoliciesMember-Centered ModelAudit ReadinessClosed-Loop ReferralsCost-of-Care MetricsStakeholder Engagement

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Own the SHP Behavioral Health program portfolio, including Utilization Management, Case Management, Care Navigation, and ASD/ABA programs
Integrate BH programs into a single member-centered model
Translate SHP contractual commitments into sustainable operations and governance
Lead governance, RAID management, leadership reporting, implementation, process improvement, and change management
Maintain SHP-specific BH policies and workflows across UM, CM, Navigation, Appeals, Claims, and Customer Service
Support the integrated ABA UM and CM model and monitor utilization, spend, and outcomes
Support BH navigation processes with closed-loop referrals
Partner on MHPAEA parity and NQTL analyses
Lead audit readiness for NCQA, NCDOI, and federal and state requirements
Manage BH vendors and delegated entities through KPI monitoring, operating reviews, and corrective action
Define and track BH access, utilization, authorization timeliness, ABA outcomes, member experience, and cost-of-care metrics
Partner with clinical, enterprise, compliance, network, vendor, analytics, and stakeholder teams

Requirements

What you’ll need

Bachelor's degree or advanced degree (where required)
5+ years of experience in related field
In lieu of degree, 7+ years of experience in related field
Experience leading programs in behavioral health, health plan operations, care management, or utilization management
Working knowledge of ASD and ABA services, MHPAEA and NQTL concepts, NCQA standards, and North Carolina regulatory requirements
Experience managing vendor or delegated-entity relationships, including performance and service-level oversight
Strong skills in program governance, risk and change management, and cross-functional facilitation
Ability to translate complex information into clear recommendations for executive, clinical, and client audiences
Behavioral health clinical background or licensure and/or PMP certification is a plus

Benefits

Comp & perks

Work-life balance, flexibility, and autonomy
Medical, dental, and vision coverage
Health and wellness programs
Parental leave and support
Adoption and surrogacy assistance
Career development programs
Tuition reimbursement for continued education
401k match including an annual company contribution
Paid Time Off (PTO)
Annual Incentive Bonus
Flexible remote work with intentional in-person connection