Medical Director – Behavioral Health
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Job Description
Behavioral Health Medical Director leading CareOregon’s managed-care utilization, quality, and psychiatric programs. Working from home in Oregon with provider-network and clinical-system leadership.
Responsibilities:
- Implement effective utilization review, care management, and clinical practice strategy development and improvement initiatives
- Develop, recommend, implement, execute, and manage behavioral health and integration programs
- Develop and manage clinical and wellness programs addressing member needs
- Provide psychiatric consultation to Care Management activities
- Perform benefit determinations, appeals, and quality of care investigations in behavioral health
- Develop and oversee clinical strategy and interventions for clinical systems
- Develop a high-performing system of care with measurable outcomes
- Collaborate with multidisciplinary teams and community partners
- Oversee clinical strategy for substance use disorders
- Participate in value-based payment model development for behavioral health networks
- Implement and oversee utilization, case, disease, and quality management programs
- Educate participating physicians on quality and utilization management
- Represent the health plan in professional and community activities
- Serve as medical spokesperson for service area expansions, contract negotiations, and provider expansion
- Provide advanced technical support to clinical and non-clinical staff
- Propose and implement process improvements
- Maintain workload deadlines, schedule, cooperation, teamwork, and cross-training
- Report through a matrix relationship to the Senior Medical Director
Requirements:
- Doctor of medicine or osteopathy in the specialty area of pediatric/adolescent psychiatry
- Possession of or ability to obtain an unrestricted license to practice in Oregon
- Minimum 5 years of relevant and progressive experience in a managed care organization or practice setting, preferably with Medicaid, including or following strong clinical practice activity
- Minimum 4 years’ experience in a supervisory position (preferred)
- Board certification (preferred)
- Knowledge of medical policy related to quality, case and disease management and credentialing activities
- Thorough knowledge of the adult mental health system of care, including state hospital, criminal justice, and involuntary commitment processes
- Working knowledge of children’s system of care and Wraparound program
- Clinical knowledge of management of diverse medical problems
- Knowledge of regulatory and contractual requirements for Medicaid, Medicare, and commercial insurance
- Understanding of managed care operations
- Demonstrated use of quality management techniques in a large, organized managed care setting
- Familiarity with guideline development, outcomes management, population health improvement, disease management, cost effectiveness, and cost analysis studies
- Ability to work effectively with diverse individuals and groups
- Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day
Benefits:
- Bonus opportunity
- Medical, dental, vision, life, AD&D, and disability insurance
- Health savings account
- Flexible spending account(s)
- Lifestyle spending account
- Employee assistance program
- Wellness program
- Discounts
- Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings
- Retirement plan with employer contributions
- PTO
- Paid State Sick Time
- Paid holidays
- Volunteer time
- Jury duty leave
- Bereavement leave
- 401(k) contributions for non-benefits eligible employees
- Flexible work arrangement: Work from home
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