Behavioral Health Medical Director

KHS•Bakersfield, CA

26d

About The Position

To apply, please send your resume or CV to Jessica Davis at [email protected] . For more information, contact Jessica Davis at 949-620-6234. The Behavioral Health Medical Director will provide clinical leadership and guidance in the development and measurement of the strategic approach to quality, performance improvement, and patient satisfaction with the Kern Health Systems (KHS) Behavioral Health Department. This position plays an important role in assuring KHS Behavioral Health (BH) Services meets its obligation to provide high quality and cost-effective care to covered beneficiaries. The Behavioral Health Medical Director is expected to possess an advanced knowledge of health care delivery systems and managed care regulatory requirements, to include, but is not limited to CMS Regulatory, Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Compliance policies. The Behavioral Health Medical Director provides medical oversight into the medical appropriateness and necessity of healthcare services provided to Plan members and is responsible for meeting medical cost and utilization performance targets.

Requirements

Full formal licensure in the State of California as a PhD or Licensed Psychiatrist and M.D. in good standing in the state of California.
10 years of management experience providing direct clinical, case management experience, and knowledge regarding rehabilitation philosophy
5 years of verifiable professional leadership experience administering program operations in a behavioral healthcare setting with knowledge of utilization review and management, with expertise of Health Plan and Drug Medical Organized Delivery Systems

Responsibilities

Provide clinical leadership and guidance across various areas within the BH Department pertaining to non-specialty and specialty mental health care and practice management
Oversee, monitor and report BH programs outcome evaluations
Oversee the development and implementation of clinical standards in coordinating and arranging children’s and adult mental health programs.
Establish and recommend service delivery plans.
Review and evaluate DHCS contract provisions pertaining to children/adult mental health services to ensure compliance with federal, state, and local laws, regulations, and industry standards.
Ensure that programs adhere to state mandated requirements for treatment, diagnosis, and medication management.
Ensure the implementation of evidence-based practices in psychiatric care across all programs
Assess clinical policies and procedures annually and revises and implements as appropriate.
Establish and maintain the infrastructure and processes necessary to develop, revise and apply authorization criteria and clinical decision support tools
Participate in BH regulatory audits and as necessary prepare responses to departmental inquiries from the DHCS and DMHC related to BH matters.
Develops over and underutilization studies and manages assessment methodologies to include statistical analysis of pre-established standards of health care quality BH measures.
Performs inter-rater reliability audits of clinical staff in accordance with BH IRR Policy and procedures and reports the outcomes to the UM/QIHECT Committee.
Collaborates with contracted BH providers to facilitate peer to peer intervention and maintains and reports aggregate data review of this activity.
Prepare executive-level reports, correspondence, and other communications for various stakeholders.
Assist in preparing presentations and reports for the KHS Executive Team, CMO, Board and other legislative authorities.
Represent KHS at BH County meetings, conferences, and forums with other public and private agencies, organizations, or councils
Acts as a resource and serves as a liaison with contracted providers, and county BH service agencies such as Regional Centers and School Based Service providers for issues relating to BH within the Service Area.
Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
Performs other job-related duties as assigned.