Medical Director – Behavioral Health

This is a fully remote position, open to applicants in Oregon.

📋 Description

• Execute effective utilization review, care management, and the development and enhancement of clinical practice strategies.

• Design, propose, implement, execute, and oversee behavioral health and integration initiatives.

• Create and manage clinical and wellness programs tailored to meet member needs.

• Provide psychiatric consultation for Care Management activities.

• Conduct benefit determinations, appeals, and quality of care investigations in the realm of behavioral health.

• Develop and supervise clinical strategies and interventions for clinical systems.

• Establish a high-performing care system with measurable outcomes.

• Collaborate with multidisciplinary teams and community partners.

• Oversee clinical strategies concerning substance use disorders.

• Engage in the development of value-based payment models for behavioral health networks.

• Implement and manage utilization, case, disease, and quality management programs.

• Educate participating physicians on quality and utilization management practices.

• Represent the health plan in both professional and community activities.

• Act as the medical spokesperson for service area expansions, contract negotiations, and provider growth.

• Provide advanced technical support to both clinical and non-clinical staff.

• Suggest and implement process enhancements.

• Maintain deadlines for workload, scheduling, cooperation, teamwork, and cross-training.

• Report through a matrix relationship to the Senior Medical Director.

⛳️ Requirements

• Doctor of Medicine or Osteopathy specializing in pediatric/adolescent psychiatry.

• Must possess or be able to obtain an unrestricted license to practice in Oregon.

• At least 5 years of relevant and progressive experience in a managed care organization or practice setting, preferably involving Medicaid, including or following substantial clinical practice activity.

• Minimum of 4 years’ experience in a supervisory role (preferred).

• Board certification (preferred).

• Comprehensive knowledge of medical policies related to quality, case management, disease management, and credentialing activities.

• In-depth understanding of the adult mental health system of care, including state hospitals, criminal justice, and involuntary commitment processes.

• Familiarity with the children's system of care and the Wraparound program.

• Clinical expertise in managing a variety of medical issues.

• Knowledge of regulatory and contractual obligations for Medicaid, Medicare, and commercial insurance.

• Understanding of managed care operations.

• Proven application of quality management techniques in a large, structured managed care environment.

• Acquainted with guideline development, outcomes management, population health improvement, disease management, cost effectiveness, and cost analysis studies.

• Ability to work efficiently with diverse individuals and groups.

• Capable of seeing, reading, hearing, speaking clearly, and performing repetitive finger and wrist movements for a minimum of 6 hours per day.

🏝️ Benefits

• Bonus opportunity.

• 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.

• Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings.

• Retirement plan with employer contributions.

• PTO.

• Paid State Sick Time.

• Paid holidays.

• Volunteer time.

• Jury duty leave.

• Bereavement leave.

• 401(k) contributions for non-benefits eligible employees.

• Flexible work arrangement: Work from home.