Medical Director, Behavioral Health

Molina Healthcare; Florida; Sur place; USD 186 000 - 363 000; Plein temps

Avantages offerts par ce poste

Competitive benefits package

Résumé du poste

Molina Healthcare in Florida seeks an experienced physician leader to provide behavioral health oversight and clinical leadership for utilization management, care management, and chemical dependency services within our plans.

You will collaborate with regional medical directors to standardize policies, support quality benchmarks with NCQA and CMS, and guide enterprise-wide training on psychiatric diagnoses and treatment.

Qualifications

• MD or DO with active, unrestricted license in the practice state.
• Board certification in Psychiatry (Child and Adolescent).
• At least 3 years of relevant experience, including 2 years in psychiatry/behavioral health.
• Knowledge of applicable national/state/local laws and regulatory requirements.

Responsabilités

• Provide behavioral health oversight and clinical leadership for utilization management and care programs.
• Facilitate regional medical necessity reviews and cross coverage.
• Standardize behavioral health goals across lines of business.
• Respond to behavioral health RFP sections and review state contracts.
• Assist with enterprise-wide education on psychiatric diagnoses and treatment.
• Provide second level behavioral health reviews, peer reviews and appeals.
• Support behavioral health committees for quality compliance.
• Track programs for NCQA and CMS quality compliance.
• Assist with recruitment and orientation of new psychiatric medical directors.

Connaissances

Clinical leadership

Utilization management

Cross-functional collaboration

Communication

Time management

Critical thinking

Attention to detail

Multi-tasking

Regulatory awareness

Formation

MD/DO with active license

Board Certification in Psychiatry (Child & Adolescent)

Outils

Microsoft Office

Description du poste

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs.
• Facilitates behavioral health-related regional medical necessity reviews and cross coverage.
• Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses.
• Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts.
• Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment.
• Provides second level behavioral health clinical reviews, peer reviews and appeals.
• Supports behavioral health committees for quality compliance.
• Implements behavioral health specific clinical practice guidelines and medical necessity review criteria.
• Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS).
• Assists with the recruitment and orientation of new psychiatric medical directors.
• Ensures all behavioral health programs and policies are in line with industry standards and best practices.
• Assists with new program implementation and supports for health plan in-source behavioral health services.

Required Qualifications

• At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience.
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice.
• Board Certification in Psychiatry (Child and Adolescent Psychiatry).
• Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
• Ability to work cross-collaboratively within a highly matrixed organization.
• Strong organizational and time-management skills.
• Ability to multi-task and meet deadlines.
• Attention to detail.
• Critical-thinking and active listening skills.
• Decision-making and problem-solving skills.Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.

Preferred Qualifications

• Experience with utilization/quality program management.
• Managed care experience.
• Peer review experience.
• Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.