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Behavioral Health Medical Director

North Seattle, WA · Healthcare
Behavioral Health Medical Director - Health Plan
North Seattle, WA (Northern Suburb near Lynnwood)
 
 *** Generous Relocation Package available to attract top talent from around the Nation! ***
 
Behavioral Health Medical Director Job Summary: 
 
  • Provides psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. 
  • Indirectly supervises Health Plan Psychiatric Medical Directors in implementing integrated Behavioral Health (BH) care management programs. 
  • Works closely with the VP of Behavioral Health and National Medical Directors to develop standardized utilization management policies and procedures to be implemented enterprise-wide that will improve quality outcomes and decrease costs.  
  • Develops scorecard benchmarks for Behavioral Health (BH) clinical staff productivity.
  • Standardizes utilization review practices and quality and financial goals across all LOBs.
  • Responds to BH-related RFP sections and review BH portions of state contracts.
  • Works with trainers to develop and provide enterprise-wide teaching on psychiatric diagnoses and treatment.
  • Writes, refines, and approves BH Policies and Procedures for utilization and case management.
  • Provides second level BH clinical reviews, BH peer reviews and appeals.
  • Works with VP Pharmacy to establish standard Psychiatric formulary.
  • Implements clinical practice guidelines and medical necessity review criteria.
  • Tracks all clinical programs for BH quality compliance with NCQA and CMS.
  • Participates in the recruitment, placement and orientation of new HP Psychiatric MDs.
  • Ensures all BH programs and policies are in line with industry standards and best practices.
  • Assists with new program implementation and supports the health plan in-source BH services.
  • Assist with reviewing and evaluating BH vendors.
 
 
Behavioral Health Medical Director Profile: 
 
  • Formal education including a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree, with Board Certification in Addiction Psychiatry.
  • Must hold an active unrestricted license to practice medicine.
  • Around 5 years clinical experience practicing psychiatric medicine, with at least 2 years in an administrative capacity.
  • Requires 2 years of Medical Director experience
  • Requires 5-7 years’ experience in Behavioral Health / Mental Health / Substance Abuse in a Managed Care Organization, including direct Utilization Review, Quality Improvement and/or Peer Review experience.
  • At least 3 years of Utilization Review /Quality Management program management
  • Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
  • Substantial knowledge of mental health and chemical dependency services and practices, including a broad band of treatment techniques, procedures, and discharge planning.
  • Prefer prior experience with peer review, medical policy/procedure development, provider contracting experience.
  • Prefer experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, and/or risk management/risk adjustment.
  • Excellent written and verbal communication skills; and strong critical thinking, deductive reasoning and decision-making skills are needed.
  • Ability to implement complex programs and to monitor implementation and modifications.

#Clinical
 
 
RON AMODIO
STRATEGIC DIRECTOR, EXECUTIVE SEARCH DIVISION

CareNational
ron@carenational.com
480.269.9491 (CALL – TEXT – FAX)
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