Medical Director, Behavioral Health
Company: Molina Healthcare
Posted on: May 19, 2019
Medical Director, Behavioral Health Description: Job DescriptionJob
SummaryMolina's Behavioral Health function provides leadership and
guidance for utilization management and case management programs
for mental health and chemical dependency services and assists with
implementing integrated Behavioral Health care management
programs.Knowledge/Skills/AbilitiesAddiction Psychiatry boarded
Provides Psychiatric leadership for utilization management and case
management programs for mental health and chemical dependency
services. Indirectly supervises Health Plan Psychiatric Medical
Directors in implementing integrated Behavioral Health care
management programs. Works closely with the MHI VP of Behavioral
Health and National Medical Directors to develop standardized
utilization management policies and procedures to be implemented
enterprise-wide that will improve quality outcomes and decrease
costs. Develops scorecard benchmarks for Behavioral Health (BH)
clinical staff productivity. Standardizes UM practices and quality
and financial goals across all LOBs. Responds to BH-related RFP
sections and review BH portions of state contracts. Works with
trainers to develop and provide enterprise-wide teaching on
psychiatric diagnoses and treatment. Writes, refines, and approves
BH Policies and Procedures for utilization and case management.
Provides second level BH clinical reviews, BH peer reviews and
appeals. Facilitates BH committees for quality compliance. Works
with VP Pharmacy to establish standard Psychiatric formulary.
Implements clinical practice guidelines and medical necessity
review criteria. Tracks all clinical programs for BH quality
compliance with NCQA and CMS. Participates in the recruitment,
placement and orientation of new HP Psychiatric MDs. Ensures all BH
programs and policies are in line with industry standards and best
practices. Assists with new program implementation and supports the
health plan in-source BH services. Assist with reviewing and
evaluating BH vendors.Qualification: Job QualificationsRequired
EducationDoctorate Degree in Medicine (MD or DO) with Board
Certification in Addiction Psychiatry Required Experience 2 years
previous experience as a Medical Director. 3 years experience in
Utilization/Quality Program Management. 5+ years clinical practice.
5+ years HMO/Managed Care experience. Current clinical knowledge.
Experience demonstrating strong management and communication
skills, consensus building and collaborative ability, and financial
acumen. Knowledge of applicable state, federal and third party
regulations Required License, Certification, Association Board
Certified in Addiction Psychiatry. Active and unrestricted State
Medical License, free of sanctions from Medicaid or Medicare.
Preferred EducationN/APreferred 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. Preferred
License, Certification, AssociationN/ATo all current Molina
employees\: If you are interested in applying for this position,
please apply through the intranet job listing.Molina Healthcare
offers a competitive benefits and compensation package. Molina
Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Keywords: Molina Healthcare, Seattle , Medical Director, Behavioral Health, Healthcare , Bothell, Washington
Didn't find what you're looking for? Search again!