Medical Director, Behavioral Health (TX / WA) (Rio Rancho)
New Mexico StaffingRio Rancho, NM, United States- Full-time
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.
Provides 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.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $161,914.25 - $315,733 / ANNUAL
- Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
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