Medical Director – Behavioral Health Services

Medical Director – Behavioral Health Services

Requirements

• Doctorate Degree in Medicine
• Washington state license as a MD without restrictions, limitations, or sanctions from government programs
• Board certification by the American Board of Psychiatry and Neurology
• 2+ years experience leading and supporting behavioral health program development and innovation required
• 2+ years experience working with behavioral health regulatory agencies required
• 2+ years experience supporting large-scale behavioral health strategy required

Responsibilities

• Provides clinical leadership and support of the Chief Medical Officer to direct and coordinate the behavioral health medical management, quality improvement and credentialing functions for the business unit
• Participates in performance and quality based on changes in the healthcare or medical arena
• Fosters Clinical Practice Guideline implementation and evidence-based medical practice
• Interprets existing policies and participates in developing new policies
• Participates as needed in regulatory, professional and community activities to provide input and become knowledgeable regarding regulatory, professional and community standards and issues
• Ensures that the medical care provided meets the standards for acceptable medical care
• Develops, Implements and Conducts concurrent and retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care
• Leads, develops, directs and implements clinical and non-clinical development of Program implementation following State directives and guidelines
• Develops, Implements and Conducts the evaluation of authorization requests in timely manner and provide support for the CM and RN reviewers and manages the denial process
• Partner with senior leadership, clinical teams, operations, and external partners to shape the strategic direction for behavioral health care delivery across the health plan
• Oversee and lead the development, implementation, and ongoing optimization of behavioral health program and strategies across the health plan
• Serve as the internal subject matter expert on behavioral health, providing strategic consultation and guidance to cross-functional partners such as Utilization Management, Care Management, Network, Quality, etc.
• Interpret and implement clinical guidelines and policies related to behavioral health
• Advise on the latest best practices, treatment protocols, and regulatory requirements in behavioral health care
• Represent the organization for legislative and government affairs initiatives such as mental health parity, community services overutilization, prior authorization, and utilization management reform
• Analyze data related to behavioral health outcomes and program effectiveness; utilizes insights to inform strategy and program development
• Monitor and analyze medical trends to assess program effectiveness, identify gaps in services, and inform decision-making processes
• Monitor key performance indicators to drive continuous improvement
• Build strong cross-functional relationships with PHCO, Network & Quality to implement business strategies
• Translate high-level strategies into actionable plans, ensuring alignment with corporate goals and objectives
• Stay informed of changes in healthcare policies and adapt programs accordingly
• Ensure all behavioral health programs adhere to state and federal regulations, accreditation standards, and best practices
• Performs other duties as assigned
• Complies with all policies and standards

Preferred Qualifications

• 2+ years experience partnering with cross-functional teams to produce position statements and operations playbooks preferred
• Additional board certification in child and adolescent psychiatry and/or Addiction Medicine highly preferred