Medical Director, Behavioral Health (TX / WA) (Provo)

Behavioral Health Medical Director

Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.

Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs.

Provide regional medical necessity reviews and cross coverage

Standardizes UM practices and quality and financial goals across all LOBs

Responds to BH-related RFP sections and review BH portions of state contracts

Assist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatment

Provides second level BH clinical reviews, BH peer reviews and appeals

Supports BH committees for quality compliance

Implements clinical practice guidelines and medical necessity review criteria

Tracks all clinical programs for BH quality compliance with NCQA and CMS

Assists with the recruitment and orientation of new Psychiatric MDs

Ensures all BH programs and policies are in line with industry standards and best practices

Assists with new program implementation and supports the health plan in-source BH services

Additional duties as assigned

Job Qualifications

REQUIRED EDUCATION :

Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry

REQUIRED EXPERIENCE :

2 years previous experience as a Medical Director in clinical practice

3 years' experience in Utilization / Quality Program Management

2+ years HMO / Managed Care experience

Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.

Knowledge of applicable state, federal and third-party regulations

Required License, Certification, Association

Active and unrestricted State (TX) Medical License, free of sanctions from Medicaid or Medicare.

Preferred Experience

Peer Review, medical policy / procedure development, provider contracting experience.

Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group / IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.