Medical Director Behavioral Health
2 days ago
Job Summary:
Molina Healthcare is seeking a highly skilled Medical Director to lead our Behavioral Health function. The successful candidate will provide leadership and guidance for utilization management and case management programs for mental health and chemical dependency services.
Key Responsibilities:
- Provide psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services.
- Work closely with Regional Medical Directors to standardize utilization management policies and procedures to improve quality outcomes and decrease costs.
- Respond to BH-related RFP sections and review BH portions of state contracts.
- Assist in the development of enterprise-wide teaching on psychiatric diagnoses and treatment.
- Provide second-level BH clinical reviews, BH peer reviews, and appeals.
- Support BH committees for quality compliance.
- Implement clinical practice guidelines and medical necessity review criteria.
- Track all clinical programs for BH quality compliance with NCQA and CMS.
- Assist with the recruitment and orientation of new Psychiatric MDs.
- Ensure all BH programs and policies are in line with industry standards and best practices.
- Assist with new program implementation and support the health plan in-source BH services.
Requirements:
- Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry.
- 2 years previous experience as a Medical Director in clinical practice.
- 3 years' experience in Utilization/Quality Program Management.
- 2+ years HMO/Managed Care experience.
- Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
- Knowledge of applicable state, federal, and third-party regulations.
Preferred Experience:
- Peer Review, medical policy/procedure development, provider contracting experience.
- Experience with NCQA, HEDIS, Medicaid, Medicare, and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $161,914.25 - $315,732.79 / ANNUAL
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