Medical Director, Behavioral Health - Long Beach, United States - Molina Healthcare

Molina Healthcare

Verified Company

Long Beach, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Summary

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.

Knowledge/Skills/Abilities

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 BHrelated RFP sections and review BH portions of state contracts
Assist the BH MD lead trainers in the development of enterprisewide 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 insource BH services
Additional duties as assigned

Job Qualifications

REQU I RED ED U C A TI O N:

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

REQU I RED E X PE R I E N C E:

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 thirdparty regulations

Required License, Certification, Association

Active and unrestricted State 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 evidencebased 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, $315,732.79 / ANNUAL