Leadership Position: Behavioral Health Clinical Director
7 days ago
About the Role
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 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 health care system in California.
In this leadership position, you will provide clinical leadership to the behavioral health medical director team, overseeing the overall Behavioral Health Clinical strategy and serving as a subject matter expert in behavioral health. You will also be responsible for providing clinical, regulatory, and quality improvement resources and thought leadership within the organization and externally with provider groups and community partners.
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
- Engage in telephonic physician-to-physician discussions regarding current members in various levels of care or who may be receiving other specialized services
- Train BSC utilization 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
- Lead a team of physicians and psychologists
Requirements:
- 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
- Minimum of 2 years of previous medical leadership experience
- 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
- Requires broad management and leadership knowledge to lead project teams and/or multiple job areas
Pay Range:
The estimated salary for this role is $254,545.00 to $360,000.00 per year for California residents. Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Salaries are based on a variety of factors, including the candidate's experience, location, and current employee salaries for similar roles.
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