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:
Behavioral Health Medical Director Profile:
- 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.
- 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.