Current jobs related to Senior Medical Director, Behavioral Health - Rancho Cordova CA - Blue Shield of California
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Senior Medical Director, Behavioral Health
3 hours ago
Rancho Cordova, CA, United States Blue Shield of California Full timeThe Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide leadership to...
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Senior Medical Director, Behavioral Health
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Rancho Cordova, CA, United States Blue Shield of California Full timeThe Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide leadership to...
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Senior Medical Director, Behavioral Health
3 hours ago
Rancho Cordova, CA, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 months ago
Rancho Cordova, CA, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Rancho Cordova, CA, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 days ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 months ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
1 week ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
3 months ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 months ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
1 week ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 months ago
Rancho Cordova, United States Blue Shield of California Full timeYour RoleThe Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 days ago
Rancho Cordova, United States Blue Shield of California Full timeYour RoleThe Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 days ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
2 days ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
24 hours ago
Rancho Cordova, United States Blue Shield of California Full timeYour Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide...
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Senior Medical Director, Behavioral Health
4 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled and experienced Senior Medical Director, Behavioral Health to join our team at Blue Shield of California. As a key member of our Medical Management team, you will provide leadership and expertise in behavioral health clinical strategy and subject matter expertise.Key ResponsibilitiesProvide oversight of the...
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Senior Medical Director, Behavioral Health
4 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeYour RoleThe Medical Management team at Blue Shield of California is dedicated to ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California. As the Senior Medical Director, Behavioral Health, you will report to the Vice President, Medical...
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Medical Director, Behavioral Health
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Rancho Cordova, CA, United States Blue Shield of California Full timeYour 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...
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Medical Director, Operations
2 weeks ago
Rancho Cordova, CA, United States Blue Shield of California Full timeThe 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, Operations (Behavioral Health) will report to the Senior Medical Director, Behavioral Health. Review pre- and post-service behavioral health...
Senior Medical Director, Behavioral Health
2 months ago
Your Role The Medical Management team ensures that Blue Shield of California 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 Senior Medical Director, Behavioral Health will report to the Vice President, Medical Management. In this role you will provide leadership to the behavioral health medical director team and have core responsibilities in the areas of psychiatric inpatient concurrent review, pre and post service utilization review, and collaboration with RN Care Managers. The Senior Medical Director, Behavioral Health will service as clinical, regulatory and quality improvement resource and clinical behavioral health thought leader within the organization and externally with provider group and community partners. This role will be responsible for the overall Behavioral Health Clinical strategy and subject matter expertise in behavioral health.
Provide oversight of the clinical behavioral health program, including managing the behavioral health medical director team
Chair behavioral health committee and participate in additional committees as the expert on clinical behavioral health
Provide behavioral health subject matter expertise for regulators, mandates, legal, external communications, and others as necessary
Participate in internal and external audits and clinical oversight of behavioral health delegates
Provide behavioral health clinical leadership and support to staff (clinical and non-clinical)
Serve as subject matter expert for the clinical behavioral health strategy and growth
Provide expertise and guidance around behavioral health utilization management program to support all lines of business
Review pre- and post-service behavioral health service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP (spell out acronym) medical policy, as well as legal and regulatory requirements. Medical decision-making and support for the behavioral health review for all services currently requiring authorization or review, facilitating appropriate use of all resources, including safe and timely discharges
Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield provider
Train BSC utilizations and care management staff which may include physicians, psychologists, nurses, social workers, and others as needed
Perform clinical reviews to support utilization management and fraud waste and abuse case evaluations
Participate with the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes for our members
Participate on projects and committees, as necessary
A Medical degree (M.and 12 years’ experience, including a minimum of 5 years’ behavioral health clinical experience preferably including hospital experience
Unrestricted California State Medical License required
Board Certification in one of ABMS categories, preferably in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Association (AOA)
A minimum of 5 years of experience in active clinical behavioral health practice with active recent inpatient psychiatric hospital experience (within the past five years) is desirable
A minimum of 3-5 years of Health Plan experience in commercial, Medicare Advantage and Medi-Cal utilization management, case review, and/or quality improvement activities in a managed care setting is preferred but not required for this position
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 a core competency
Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements. The ideal candidate will be a highly talented psychiatrist with managed care experience supporting utilization management of all levels in behavioral health
An ability to understand overall managed care organization, business strategies, and financial metrics; Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communications
Strong collaboration skills to effectively work within a team that may consist of diverse individuals who bring a variety of different skills ranging from medical to behavioral, project management and more
