Medical Director, Behavioral Health

Viva Health • Birmingham, AL

388d

About The Position

The Medical Director, Behavioral Health at VIVA HEALTH is a part-time role focused on overseeing clinical and policy responsibilities related to behavioral health services. This position requires a deep understanding of psychiatric practices and the ability to communicate effectively across various levels of management. The Medical Director will work to enhance the value of services provided to members, particularly those with mental illness, substance abuse issues, and neurocognitive disorders, while ensuring compliance with federal guidelines and improving overall member care.

Requirements

• Medical degree from an accredited University
• 10 or more years' clinical experience in an inpatient and/or outpatient setting
• Current Physician license in good standing in the state of Alabama
• Board Certified Physician
• Experience dealing with serious mental illness and comorbid conditions
• Strong interprofessional communication skills
• Sensitivity to health equity and parity issues

Nice To Haves

• Familiarity with major publications on care for at-risk populations
• Experience in a health maintenance organization (HMO) setting

Responsibilities

• Recommend policies aligned with federal guidelines and assess fiscal impact.
• Monitor state and national policies regarding Behavioral Health, including CMS Star measures and HEDIS metrics.
• Alert management to policy changes and propose interventions to enhance audit results and member care.
• Provide guidance to care management teams on strategies for assisting complex members with multiple comorbidities.
• Conduct timely Peer-to-Peer reviews and assess authorizations for renewal or discontinuation.
• Perform medical record reviews for members not meeting medical necessity for inpatient care.
• Review cases of extended stays or rapid readmissions to monitor quality of care.
• Report on new therapeutics and advise on authorization questions and risk adjustments.
• Identify cost containment opportunities related to psychiatric comorbidities.
• Promote education on behavioral health for members, staff, and providers.
• Support internal staff in Quality, Pharmacy, and Credentialing departments to develop policies and goals.
• Advise on operational processes and workflow changes to maximize efficiency.

Benefits

• Part-time flexible work schedule
• Opportunity to work with a high-performing health plan
• Engagement with a community-focused organization

What This Job Offers

• Job Type: Part-time
• Career Level: Senior
• Industry: Ambulatory Health Care Services
• Education Level: No Education Listed