Medical Director - Behavioral Health

CareOregon•WFH (Oregon), OR

5d•Remote

About The Position

The Medical Director for Behavioral Health is responsible for implementing effective utilization review, care management and other clinical practice strategy development and improvement initiatives as assigned by the Vice President of Behavioral Health. Other responsibilities may include network development, benefit management and design, and providing clinical and strategic direction in support of CareOregon delivery system improvements. This position may be assigned to lead medical management initiatives for the organization including clinical quality in the provider network, as well as utilization, quality, case management and disease management operations, monitoring and results, in the business areas of integration and behavioral health. This position has a matrix reporting relationship to the Senior Medical Director.

Requirements

Doctor of medicine or osteopathy in the specialty area of pediatric/adolescent psychiatry
Possession of or ability to obtain an unrestricted license to practice in Oregon
Minimum 5 years of relevant and progressive experience in a managed care organization or practice setting, preferably with Medicaid, including or following strong clinical practice activity
Medical policy knowledge and skills as related to quality, case and disease management and credentialing activities
Thorough knowledge of the adult mental health system of care, including state hospital, criminal justice, and involuntary commitment processes
Working knowledge of children’s system of care and Wraparound program
Clinical knowledge of the management of diverse medical problems
Proficient knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare, and commercial insurance
Effective understanding of managed care operations
Excellent communication and collaboration skills for work with network providers and internal employees
Ability to motivate and bring individuals and teams together and meld into a cohesive unit
Ability to work effectively as part of a cross-functional team and foster an environment where change is embraced and supported
Ability to deal with issues and problems systemically
Proven ability to work as an integral part of a team
Ability to plan, set priorities, delegate effectively and utilize time efficiently
Skill in applying innovative and creative approaches to improve health care delivery
Demonstrated use of quality management techniques in a large, organized managed care setting
Demonstrated commitment to improving access and quality of care to the underserved and uninsured
Appreciation of cultural diversity and the needs of serving a diverse patient population
Familiarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studies
Awareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement concepts
Demonstrated comfort, enjoyment and facility to continuously interact with professional colleagues individually and in groups concerning health management, treatment and health data
Results-oriented decision-maker with the ability to balance diverse priorities
High degree of initiative and motivation along with the ability to effectively support and collaborate with others to achieve business objectives
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day

Nice To Haves

Minimum 4 years’ experience in a supervisory position
Board certification

Responsibilities

Develop, recommend, implement, execute and manage effective programs in all clinical areas of behavioral health and integration.
Work with colleagues to develop, implement and manage clinical and wellness programs to address the needs of members.
Provide psychiatric consultation to Care Management activities throughout the organization.
Perform benefit determinations, appeals and quality of care investigations in behavioral health areas, as assigned by the VP of Behavioral Health and Senior Medical Director.
Partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems.
Work with local CCO and network clinical leadership to develop a high performing system of care with measurable outcomes.
Collaborate with diverse multi-disciplinary teams within and outside the organization; grow and leverage community partnerships.
Oversee the organizational clinical strategy to address substance use disorders.
Participate in development of value-based payment models in the BH networks.
Implement, direct and oversee utilization, case, disease, and/or quality management programs.
Develop and implement programs for educating participating physicians regarding quality management and utilization management issues.
Represent the health plan in applicable activities including medical and other professional organizations.
Participate in activities that enhance CareOregon’s image within the community.
Serve as a representative and medical spokesperson for the plan in support of service area expansions, contract negotiations and other provider expansion activities.
Serve as an advanced technical resource for clinical and non-clinical staff.
Propose and implement process improvements.
Meet deadlines for completion of workload.
Maintain agreed upon work schedule.
Demonstrate cooperation and teamwork.
Provide cross-training on specific job responsibilities.

Benefits

competitive pay
bonus opportunity
comprehensive benefits package
medical, dental, vision, life, AD&D, and disability insurance
health savings account
flexible spending account(s)
lifestyle spending account
employee assistance program
wellness program
discounts
multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
strong retirement plan with employer contributions
PTO
Paid State Sick Time
paid holidays
volunteer time
jury duty
bereavement leave