Senior Medical Director, Behavioral Health
2 days ago
We 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 Responsibilities- 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 medical policy, as well as legal and regulatory requirements.
- A Medical degree (M.D./D.O.) 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.
We offer a competitive salary range of $155,331.00 to $325,743.00 for California. Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade.
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