Senior Medical Director, Behavioral Health Specialist
6 days ago
We are seeking a highly skilled Senior Medical Director, Behavioral Health to join our team at Blue Shield of California. This is a key leadership role that will provide clinical leadership and oversight to our behavioral health program, ensuring that we deliver high-quality, patient-centered care to our members.
Key Responsibilities- Provide clinical leadership and oversight to the behavioral health medical director team
- Develop and implement clinical strategies to improve behavioral health outcomes for our members
- Collaborate with internal stakeholders to ensure seamless integration of behavioral health services
- Provide subject matter expertise on behavioral health issues to internal and external stakeholders
- Develop and maintain relationships with external partners, including providers and community organizations
- Stay up-to-date on regulatory and compliance requirements related to behavioral health
- Develop and implement quality improvement initiatives to improve behavioral health outcomes
- Provide training and education to staff on behavioral health topics
- Medical degree (M.D.) and 12 years' experience, including a minimum of 5 years' behavioral health clinical 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
- Experience with CPT coding, medical claims review, hospital billing, and reimbursement
- Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
- Ability to understand overall managed care organization, business strategies, and financial metrics
- Strong interpersonal and communication skills
- Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others
We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced leader who is passionate about delivering high-quality care to our members, we encourage you to apply for this exciting opportunity.
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