Senior Behavioral Health Medical Director

3 days ago


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

The 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 necessary behavioral health services while maintaining compliance with regulatory requirements.

About the Role

In this position, you will oversee pre- and post-service utilization reviews, collaborating closely with healthcare providers to ensure seamless transitions of care. You will also train and support care management staff on best practices for behavioral health services, including safe discharges and efficient use of resources. Your expertise in psychiatry and experience working with various levels of care will be invaluable in driving quality improvement initiatives and reducing healthcare costs.

Essential Responsibilities

*Pre- and Post-Service Utilization Reviews: Conduct thorough assessments of member needs, taking into account their benefits, medical necessity, and applicable laws and regulations.
*Clinical Decision-Making: Collaborate with healthcare providers to make informed decisions regarding member care, balancing efficiency with quality outcomes.
*Training and Support: Educate care management staff on best practices for behavioral health services, emphasizing adherence to medical policies and regulatory requirements.
*Telphonic Consultations: Engage in regular discussions with healthcare providers to facilitate timely access to necessary care, ensuring effective communication and collaboration across the continuum of care.

Required Skills and Qualifications

To excel in this role, you must possess a strong background in psychiatry, along with extensive experience working in behavioral health services. A minimum of 5 years direct patient care experience is required, with a completed residency in Psychiatry and active unrestricted licensure in California and any other assigned states. Board certification in Psychiatry is also essential. Familiarity with MHPAEA (Mental Health Parity and Addiction Equity Act), SB855, and related regulatory requirements is crucial for success in this position.

PREFERRED QUALIFICATIONS:

A minimum of 3 years of 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. Active recent inpatient psychiatric hospital experience within the past five years is desirable. Proficiency in CPT coding, medical claims review, hospital billing, and reimbursement is also a valuable asset. Additionally, familiarity with most areas of behavioral health services and conditions, along with rapid and accurate decision-making skills, are highly beneficial.

Salary Range:

The estimated salary range for this role is $209,091.00 to $330,000.00, based on location, experience, and other factors.

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

    About 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...


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

    Job DescriptionBlue Shield of California is seeking a Senior Medical Director, Behavioral Health to lead our behavioral health medical director team.This role involves overseeing clinical strategies and ensuring compliance with regulatory requirements. Direct participation in utilization reviews and quality improvement is expected, as well as providing...


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

    About 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...


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

    At Blue Shield of California, we are dedicated to accelerating the emergence of a value-based healthcare system in our state.About the RoleWe are seeking a Senior Medical Director, Behavioral Health to lead our behavioral health medical director team and oversee clinical strategies. This role involves direct participation in utilization reviews and quality...


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

    At Blue Shield of California, we are committed to delivering high-quality healthcare services that meet the evolving needs of our members. We are seeking a highly skilled and experienced Senior Medical Director, Behavioral Health to join our team.


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

    Job 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 time

    At Blue Shield of California, we are dedicated to providing exceptional mental health services to our members.About the RoleWe are seeking a highly skilled and experienced Medical Director, Behavioral Health to join our team. As a key member of our medical management team, you will play a critical role in ensuring the quality and efficiency of our mental...


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

    Your OpportunityJoin 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...


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

    Job OverviewWe are seeking a skilled Medical Director, Behavioral Health to join our team at Blue Shield of California. In this role, you will play a critical part in ensuring that we provide high-quality behavioral health services to our members.About the RoleThe Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral...


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

    Key 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...


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

    About the RoleAs a Senior Medical Director, Behavioral Health at Blue Shield of California, you will lead our clinical strategy in behavioral health services. You will oversee the clinical behavioral health program and provide leadership to the behavioral health medical director team.Your Key ResponsibilitiesChair the behavioral health committee and...


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

    About the RoleWe 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.ResponsibilitiesOversee pre- and post-service utilization reviews to ensure compliance...


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

    About the RoleWe are seeking a seasoned Behavioral Health Care Leader to join our team at Blue Shield of California.Job SummaryThe Medical Director, Behavioral Health will lead our medical management efforts to ensure that we stay at the forefront of medical, medication, and payment policy innovation. This role will require expertise in clinical...


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

    About the RoleThe Medical Director, Behavioral Health will lead the Medical Management team in ensuring Blue Shield of California is at the forefront of medical, medication, and payment policy to accelerate a value-based healthcare system.


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

    Job Description:We are seeking a Senior Behavioral Health Case Manager to join our team at Blue Shield of California. As a key member of our care management team, you will play a vital role in providing high-quality care to our members.About the Role:This is a permanent position that requires a Bachelor's degree in Nursing and current RN licensure. The ideal...


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

    At Blue Shield of California, we are seeking a Medical Director, Behavioral Health to join our team.This critical role plays a pivotal part in ensuring the quality and efficiency of mental health services. The successful candidate will oversee pre- and post-service utilization reviews, collaborate with healthcare providers, and train care management staff to...


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

    Job OverviewIn this leadership role, you will oversee the implementation and execution of clinical strategies to drive behavioral health services at Blue Shield of California.The ideal candidate will possess a deep understanding of mental health parity and addiction equity laws, as well as experience in utilization management and case review.


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

    The role of a Senior Utilization Management Nurse at Blue Shield of California involves reviewing inpatient stays to ensure medical necessity and compliance with state and federal regulations. This position requires the application of guidelines for nationally recognized levels of care, as well as collaboration with team members to enhance patient...


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

    At Blue Shield of California, we are seeking a seasoned Senior Healthcare Operations Director to lead our Utilization Management department. This critical role plays a vital part in ensuring timely and cost-effective care for our Commercial members.In this position, you will oversee the development and implementation of operational efficiencies through...


  • Rancho Cordova, California, United States Cordova Community Medical Center Full time

    Job Title: Nurse Director Emergency Care and Medical ServicesAt Cordova Community Medical Center, we are seeking a skilled and experienced Nurse Director of Emergency Care and Medical Services to lead our team in delivering high-quality patient care.As the leader of our Emergency Room, Acute and Swing/Med Surg Units, you will play a vital role in ensuring...