Behavioral Health Clinical Strategy Lead

5 days ago


Rancho Cordova, California, United States Blue Shield of California Full time

Your Opportunity

Join Blue Shield of California as a Senior Medical Director, Behavioral Health and take the lead in shaping the organization's behavioral health clinical strategy.

This role is responsible for overseeing the clinical behavioral health program, managing the behavioral health medical director team, and providing subject matter expertise to regulators, mandates, legal, external communications, and others as necessary.

In this capacity, you will:

  • Lead the development and implementation of the behavioral health clinical strategy, aligning with the organization's goals and objectives
  • Chair the 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
  • Serve as a clinical leader and resource to staff (clinical and non-clinical)
  • Develop and maintain relationships with external partners, including providers, community organizations, and regulatory agencies

You will be responsible for reviewing pre- and post-service behavioral health service requests and rendering decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP medical policy, as well as legal and regulatory requirements.

To succeed in this role, you will need a strong background in behavioral health, with a minimum 5 years direct patient care experience post-residency. You should have a medical degree (M.D./D.O.), completed residency in Psychiatry, and maintain active, unrestricted California State Medical License. Additionally, you should have Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP). Previous medical leadership experience is also required.

Priorities for Success

  • Clinical Leadership and Expertise: Provide high-quality clinical leadership and subject matter expertise to support the development and implementation of the behavioral health clinical strategy
  • Team Management: Oversee the behavioral health medical director team and ensure effective collaboration and communication among team members
  • Regulatory Compliance: Ensure compliance with all relevant laws, regulations, and policies related to behavioral health
  • Relationship Building: Develop and maintain strong relationships with external partners, including providers, community organizations, and regulatory agencies

About Us

Blue Shield of California is a leading health plan committed to improving the health and wellness of our members. We are dedicated to providing high-quality, affordable healthcare services that meet the unique needs of our diverse membership.

Salary Range

The salary range for this role is $254,545.00 to $360,000.00 per year, depending on your qualifications and experience. This range represents the pay scale for similar roles within Blue Shield of California.



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