Medical Director - Behavioral Health

Medical Director - Behavioral HealthThe Medical Director for Behavioral Health is responsible for implementing effective utilization review, care management and other clinical practice strategy development and improvement initiatives as assigned by the Vice President of Behavioral Health. Other responsibilities may include network development, benefit management and design, and providing clinical and strategic direction in support of CareOregon delivery system improvements. This position may be assigned to lead medical management initiatives for the organization including clinical quality in the provider network, as well as utilization, quality, case management and disease management operations, monitoring and results, in the business areas of integration and behavioral health. This position has a matrix reporting relationship to the Senior Medical Director. Estimated Hiring Range:
$ - $ Bonus Target:

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
Essential Responsibilities

- Develop, recommend, implement, execute and manage effective programs in all clinical areas of behavioral health and integration.

- Work with colleagues to develop, implement and manage clinical and wellness programs to address the needs of members.

- Provide psychiatric consultation to Care Management activities throughout the organization.

- Perform benefit determinations, appeals and quality of care investigations in behavioral health areas, as assigned by the VP of Behavioral Health and Senior Medical Director.

- Partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems.

- Work with local CCO and network clinical leadership to develop a high performing system of care with measurable outcomes.

- Collaborate with diverse multi-disciplinary teams within and outside the organization; grow and leverage community partnerships.

- Oversee the organizational clinical strategy to address substance use disorders.

- Participate in development of value-based payment models in the BH networks.

- Implement, direct and oversee utilization, case, disease, and/or quality management programs.

- Develop and implement programs for educating participating physicians regarding quality management and utilization management issues.

- Represent the health plan in applicable activities including medical and other professional organizations.

- Participate in activities that enhance CareOregon’s image within the community.

- Serve as a representative and medical spokesperson for the plan in support of service area expansions, contract negotiations and other provider expansion activities.

- Serve as an advanced technical resource for clinical and non-clinical staff.

- Propose and implement process improvements.

- Meet deadlines for completion of workload.

- Maintain agreed upon work schedule.

- Demonstrate cooperation and teamwork.

- Provide cross-training on specific job responsibilities.

Experience and/or Education
Required

- Doctor of medicine or osteopathy in the specialty area of pediatric/adolescent psychiatry

- Possession of or ability to obtain an unrestricted license to practice in Oregon

- Minimum 5 years of relevant and progressive experience in a managed care organization or practice setting, preferably with Medicaid, including or following strong clinical practice activity

Preferred

- Minimum 4 years’ experience in a supervisory position

- Board certification

Knowledge, Skills and Abilities Required
Knowledge

- Medical policy knowledge and skills as related to quality, case and disease management and credentialing activities

- Thorough knowledge of the adult mental health system of care, including state hospital, criminal justice, and involuntary commitment processes

- Working knowledge of children’s system of care and Wraparound program

- Clinical knowledge of the managem