Medical Director, Behavioral Health (PST)

Molina Healthcare•Long Beach, CA

About The Position

Provides medical oversight and expertise related to behavioral health and chemical dependency services and assists with implementing integrated behavioral health care programs within specific markets or regions. Contributes to the overarching strategy for providing quality, cost-effective member care. The role provides behavioral health oversight and clinical leadership for health plan and market-specific utilization management and care management programs, working with regional medical directors to standardize policies and procedures and improve quality outcomes while decreasing costs. It supports medical necessity reviews, clinical reviews, peer reviews, appeals, quality compliance, clinical practice guidelines, program implementation, and the recruitment and orientation of psychiatric medical directors. The position also contributes to behavioral health education, contract and proposal review, and alignment of programs with industry standards and best practices.

Requirements

At least 3 years of relevant experience, including 2 years of medical practice experience in psychiatry or behavioral health, or an equivalent combination of relevant education and experience.
Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
Active, unrestricted license in the state of practice.
Board certification in Psychiatry.
Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
Ability to work collaboratively across a highly matrixed organization.
Strong organizational and time-management skills.
Ability to multitask and meet deadlines.
Attention to detail.
Critical-thinking and active-listening skills.
Decision-making and problem-solving skills.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs, and ability to learn new programs.

Nice To Haves

Experience with utilization or quality program management.
Managed care experience.
Peer review experience.
Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA), or another health care or management certification.

Responsibilities

Provide behavioral health oversight and clinical leadership for health plan or market-specific utilization management and care management programs and chemical dependency services.
Work with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs.
Facilitate regional behavioral health medical necessity reviews and cross coverage.
Standardize behavioral health utilization management, quality, and financial goals across all lines of business.
Respond to behavioral health sections of requests for proposals and review behavioral health portions of state contracts.
Assist lead trainers in developing enterprise-wide education on psychiatric diagnoses and treatment.
Provide second-level behavioral health clinical reviews, peer reviews, and appeals.
Support behavioral health committees for quality compliance.
Implement behavioral health clinical practice guidelines and medical necessity review criteria.
Track behavioral health clinical programs for compliance with National Committee for Quality Assurance and Centers for Medicare and Medicaid Services requirements.
Assist with recruiting and orienting new psychiatric medical directors.
Ensure behavioral health programs and policies align with industry standards and best practices.
Assist with new program implementation and support health plan in-sourcing of behavioral health services.