Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE

Cambia Health Solutions • Salt Lake, UT

8d • Remote

About The Position

This is a part-time, non-benefited position with a maximum of 12 hours per week, focused on building a career with purpose to create a person-focused and economically sustainable health care system. The Associate Medical Director BH and UM Medical Directors provide leadership and clinical oversight for behavioral health operations across all lines of business within the health plan, with a primary focus on behavioral health utilization management. This role partners with leaders and staff across the organization to ensure policies, programs, and strategies related to members are effective. The position involves conducting case reviews requiring physician involvement and providing clinical expertise to others related to behavioral health case management, prior authorizations, and appeals. Additionally, it includes providing peer-to-peer consultations with providers to enhance the member healthcare experience. This role is ideal for a motivated and experienced medical professional passionate about patient care and making a significant difference in healthcare.

Requirements

• Licensed Physician with an MD or DO degree
• Active, unrestricted license to practice medicine in one or more of our 4 states (Oregon, Washington, Idaho, Utah).
• Board Certification in general psychiatry or child psychiatry required with preference for being board certified in both.
• Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review.
• At least 3 years clinical experience.
• Two years health plan medical utilization management and/or case management experience.
• Equivalent combination of education and experience.
• Must be located in one of our four states (Oregon, Washington, Idaho, Utah).

Nice To Haves

• In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions.
• Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes.
• Passion for population health, healthcare transformation and improving the experience of people with mental health issues.
• Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.
• Proven ability to develop and maintain positive working relationships with community and provider partners.
• Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods and evolving accountable care and payment models is preferred.
• Experience conducting medical case reviews for utilization and/or case management is strongly preferred.
• Detail-oriented with orientation to the application of data and metrics in managing health, quality and program effectiveness.
• Leadership experience with demonstrated ability to effectively build relationships, work with others and lead people and project teams.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.

Responsibilities

• Completes Behavioral Health utilization management reviews, including PA, appeals and post-service.
• Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management.
• Oversees the development of effective operational policies, procedures, and standards for an integrated behavioral health program, monitors utilization and results, and implements process or system changes as needed.
• Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
• Collaborates with the Executive Medical Director of Behavioral Health, leads/participates in teams for medical policy reviews and development, and discusses review determinations with providers to promote understanding of utilization management and quality improvement policies.
• Stays abreast of industry, medical, and technology trends, identifies and communicates new opportunities to enhance outcomes and the organization's reputation, and collaborates to implement actions to reduce medical cost trend.
• Other roles as assigned.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level