Medical Director, Behavioral Health

Provides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions.

Requirements

• Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services
• Facilitates behavioral health-related regional medical necessity reviews and cross coverage
• Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses
• Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts
• Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment
• Provides second level behavioral health clinical reviews, peer reviews and appeals
• Supports behavioral health committees for quality compliance
• Implements behavioral health specific clinical practice guidelines and medical necessity review criteria
• Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS)
• Assists with the recruitment and orientation of new psychiatric medical directors
• Ensures all behavioral health programs and policies are in line with industry standards and best practices
• Assists with new program implementation and supports for health plan in-source behavioral health services