Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE

Cambia Health Solutions • Medford, OR

59d • $217,172 - $369,933 • Hybrid

About The Position

This is a part-time, non-benefited position with a maximum of 12 hours per week, focused on providing leadership and clinical oversight for behavioral health operations within the health plan, with a primary focus on behavioral health utilization management. The role involves partnering with leaders and staff across the organization to ensure policies, programs, and strategies related to members are effective. Responsibilities include conducting case reviews requiring physician involvement, providing clinical expertise for behavioral health case management, prior authorizations, and appeals, and performing peer-to-peer consultations with providers to enhance the member healthcare experience.

Requirements

• Licensed Physician with an MD or DO degree
• Active, unrestricted license to practice medicine in one or more of our 4 states.
• 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.
• Wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

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.

Responsibilities

• Develops and Implements Behavioral Health Policies and Programs: 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.
• Operational Leadership and Oversight: 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.
• Subject Matter Expert and Clinical Leadership: 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.
• Collaboration and Communication: 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.
• Industry Trends and Opportunities: 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
• Education Level: Ph.D. or professional degree