Medical Director, Behavioral Health (Part Time)

Blue Shield of CA; Lodi (CA); Hybrid; USD 210,000 - 320,000; Full time

Job summary

Blue Shield of California is seeking a Medical Director, Behavioral Health to lead the behavioral health concurrent review, pre- and post-service utilization reviews, and collaboration with Clinical Care Managers in a value-based care framework in California.

The role emphasizes rapid, accurate decision-making, strong regulatory compliance, and a track record of leading high-performing teams in managed care settings.

Qualifications

• MD/DO degree and valid medical license required.
• Completion of an ACGME psychiatry residency required.
• Active CA medical license and ability to obtain licenses in other states.
• Board certification in Psychiatry (ABPN or AOBNP) required.
• Substance use disorders and inpatient psychiatry exposure preferred.

Responsibilities

• Lead behavioral health concurrent review processes.
• Perform pre- and post-service utilization reviews.
• Collaborate with Clinical Care Managers to optimize care.
• Investigate and resolve complex behavioral health issues.

Skills

Decision making

Care review

Issue investigation & resolution

Managed care experience

Behavioral health knowledge

Regulatory compliance

Collaboration with care managers

Education

MD/DO degree

ACGME Psychiatry residency

CA Medical License (unrestricted)

Medical license in other states

Board Certification in Psychiatry (ABPN or AOBNP)

Tools

CPT coding

Medical claims review

Hospital billing

Reimbursement knowledge

ASAM LOCUS CALOCUS familiarity

Job description

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Medical degree (M.D./D.O.) required


• Completed an ACGME accredited residency in Psychiatry required


• Minimum 5 years direct patient behavioral health clinical care experience post residency required


• Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required


• Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required


• Recent inpatient psychiatric hospital experience (within the past five years)- preferred


• Recent substance use disorders treatment experience (within the past five years) preferred


• Well-versed with most areas of behavioral health services and conditions


• Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues


• Experience with CPT coding, medical claims review, hospital billing, and reimbursement is strongly preferred


• Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements is strongly preferred


• Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health is strongly preferred


• Experience with ASAM, LOCUS, and CALOCUS is strongly preferred

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.