Lead Behavioral Health Physician

1 week ago


Rancho Cordova, California, United States Blue Shield of California Full time
About the Role

We are seeking a highly skilled 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 critical role in ensuring the quality and efficiency of mental health services.

Responsibilities
  • Oversee pre- and post-service utilization reviews to ensure compliance with medical policies and regulatory requirements.
  • Collaborate with healthcare providers to develop and implement effective care plans for members with complex behavioral health needs.
  • Train care management staff on best practices in behavioral health services and support their development as experts in their field.
  • Perform clinical reviews to identify opportunities for quality improvement and develop interventions to improve outcomes for our members.
  • Participate in projects and committees to advance the goals of our Medical Management team.
Requirements

To be successful in this role, you must have:

  • A strong background in psychiatry, including a medical degree (M.D./D.O.) and completed residency in Psychiatry.
  • A minimum of 5 years direct patient care experience in behavioral health clinical settings.
  • Maintain active, unrestricted California State Medical License and additional state licenses as required.
  • Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP).
  • Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855, and all relevant regulatory and compliance requirements.
Preferred Qualifications

We prefer candidates with:

  • Active recent inpatient psychiatric hospital experience within the past five years.
  • 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.
  • Experience with CPT coding, medical claims review, hospital billing, and reimbursement.
Compensation

The estimated annual salary for this role is $209,091 - $330,000, depending on location and experience.



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