Senior Medical Director, Behavioral Health
1 week ago
We are seeking a highly skilled and experienced Medical Director to join our Behavioral Health team at Blue Shield of California. As a key member of our Medical Management team, you will play a critical role in ensuring that our organization is at the forefront of medical, medication, and payment policy to accelerate the emergence of a value-based healthcare system in California.
Key Responsibilities- Review and render decisions on pre- and post-service behavioral health service requests, ensuring compliance with member benefits, medical necessity, and regulatory requirements.
- Collaborate with Nurse Care Managers and other stakeholders to facilitate appropriate use of resources, including safe and timely discharges.
- Engage in telephonic physician-to-physician discussions regarding current members in various levels of care or receiving specialized services.
- Train BSC utilization and care management staff on clinical reviews, utilization management, and fraud waste and abuse case evaluations.
- Participate in quality management functions to identify and analyze medical information, develop interventions to improve quality of care and outcomes for members.
- Contribute to projects and committees as necessary.
- A Medical degree (M.D./D.O.) and 12 years' experience, including a minimum of 5 years' behavioral health clinical experience, preferably with 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 recent inpatient psychiatric hospital experience (within the past five years) is desirable.
- A minimum of 3-5 years of Health Plan experience in Medicare Advantage utilization management, case review, and/or quality improvement activities in a managed care setting is preferred but not required for this position.
- An ability to work independently to achieve objectives and resolve issues in ambiguous circumstances.
- Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others.
- Strong collaboration skills to effectively work within a team with diverse individuals.
- An ability to understand overall managed care organization, business strategies, and financial metrics.
- Well-versed with most areas of behavioral health services and conditions, with ability for rapid, accurate decision-making.
Blue Shield of California offers a competitive salary range of $ to $ for this role, based on experience and location. We are committed to making work-life balance a reality, offering a hybrid work model that allows you to decide where you can do your best work. We are an equal opportunity employer and welcome applications from diverse candidates. Please note that this role requires a background check and drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State, and local laws.
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