Medical Director, Behavioral Health
1 month ago
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 psychiatric inpatient concurrent review, pre- and post-service utilization review, and collaboration with Nurse Care Managers.
Your Work
In this role, you will:
- 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 (Federal Employee Program) 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
- Engage in telephonic physician-to-physician discussions regarding current members in various levels of care or who may be receiving other specialized services. Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providers
- 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
Your Knowledge and Experience
- Minimum 5 years direct patient care behavioral health clinical experience post residency required
- Medical degree (M.D./D.O.)
- Completed residency in Psychiatry
- Maintain active, unrestricted California State 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
- Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
Preferred Qualifications:
- Active recent inpatient psychiatric hospital experience (within the past five years) is desirable
- A minimum of 3 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
- Managed care experience supporting utilization management of all levels in behavioral health
- Typically has mastery level knowledge and skills within a specific technical or professional discipline with broad understanding of other areas within the job function
Pay Range:
The pay range for this role is: $ 209091.00 to $ 330000.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
#LI-SS8
Medical Director, Behavioral Health at Blue Shield of California summary:
The Medical Director of Behavioral Health at Blue Shield plays a critical role in ensuring the quality and efficiency of mental health services. Responsibilities include overseeing pre- and post-service utilization reviews, collaborating with healthcare providers, and training care management staff to ensure compliance with medical policies. This position requires a strong background in psychiatry, hands-on experience with behavioral health services, and knowledge of healthcare regulations.
Keywords:
Medical Director, Behavioral Health, Utilization Review, Mental Health Services, Healthcare Compliance, Psychiatry, Care Management, Quality Improvement, Telephonic Consultation, Patient Care
-
Medical Director, Behavioral Health
4 weeks ago
Rancho Cordova, 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...
-
Senior Medical Director, Behavioral Health
4 weeks ago
Rancho Cordova, CA, United States Blue Shield of California Full timeSenior Medical Director, Behavioral Health at Blue Shield of California summary: The Senior Medical Director, Behavioral Health leads the behavioral health medical director team at Blue Shield of California, overseeing clinical strategies and ensuring compliance with regulatory requirements. This role involves direct participation in utilization reviews...
-
Senior Medical Director, Behavioral Health
1 month 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...
-
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 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...
-
Senior Medical Director, Behavioral Health
1 month 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...
-
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 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...
-
Senior Medical Director, Behavioral Health
4 weeks 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...
-
Senior Medical Director, Behavioral Health
2 weeks ago
Rancho Cordova, United States Blue Shield of California Full timeSenior Medical Director, Behavioral Health at Blue Shield of California summary: The Senior Medical Director, Behavioral Health leads the behavioral health medical director team at Blue Shield of California, overseeing clinical strategies and ensuring compliance with regulatory requirements. This role involves direct participation in utilization reviews...
-
Medical Director, Behavioral Health
4 weeks ago
Rancho Cordova, 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...
-
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 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...
-
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 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...
-
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...
-
Senior Medical Director, Behavioral Health
4 weeks 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...
-
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...
-
Director of Behavioral Health Strategy
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeAbout the RoleThe Senior Medical Director, Behavioral Health at Blue Shield of California is responsible for leading the clinical strategy and ensuring compliance with regulatory requirements in behavioral health.Key Responsibilities:Oversight of the behavioral health medical director teamProviding expertise and guidance on behavioral health policies and...
-
Senior Behavioral Health Medical Director
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeOverviewThe Blue Shield of California organization is dedicated to improving the health and well-being of our members through a combination of innovative medical policies, quality care management, and telephonic consultations. As a Medical Director for Behavioral Health, you will play a vital role in ensuring that our members receive timely access to...
-
Director of Nursing
2 weeks ago
Pomona, CA, United States Laurel Park Behavioral Health Center Full timeDirector of Nursing - 43 Bed Behavioral Health Center Job Category: Nursing Admin Requisition Number: DIREC002819 Full-Time On-site Salary: $110,000 USD per year Locations Laurel Park Behavioral Health CenterPomona, CA 91768, USA Description Are you looking for your new career? Laurel Park Behavioral Health Center is now hiring a Director of Nursing (DON)...
-
Lead Behavioral Health Services Director
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeJob SummaryThe Medical Director of Behavioral Health plays a pivotal role in ensuring the quality and efficiency of mental health services. As a key member of our team, you will oversee pre- and post-service utilization reviews, collaborate with healthcare providers to deliver high-quality care, and train care management staff to ensure compliance with...
-
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 play a vital role in ensuring that we are on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based...
-
Behavioral Health Services Director
3 weeks ago
Rancho Cordova, California, United States Blue Shield of California Full timeKey Responsibilities:The Medical Director, Behavioral Health at Blue Shield of California plays a pivotal role in ensuring the quality and efficiency of mental health services. This position involves overseeing pre- and post-service utilization reviews, collaborating with healthcare providers, and training care management staff to ensure compliance with...
