Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE

About the role

This is a part-time non-benefited position with a maximum of 12 hours per week. Join our Cause to create a person-focused and economically sustainable health care system.

Responsibilities

• Builds policies and programs for behavioral health operations across all lines of business within the health plan.
• Ensures policies, programs, and strategies related to members are aligned with organizational goals.
• Conducts case reviews requiring physician involvement and/or provides clinical expertise in behavioral health case management, prior authorizations, and appeals.
• Provides peer-to-peer consultations with providers to support a person-focused health care experience.

Requirements

• Licensed Physician with an MD or DO degree, active, unrestricted license in one of the following states: Oregon, Washington, Idaho, or Utah.
• Board Certification in general psychiatry or child psychiatry required, with preference for both.
• At least 3 years clinical experience in behavioral health.
• Two years health plan medical utilization management and/or case management experience.

Qualifications

• In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions.
• Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to manage patient care.
• Passion for population health, healthcare transformation, and improving the experience of people with mental health issues.
• Strong communication and facilitation skills with internal staff and external stakeholders.
• Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods, and accountable care and payment models.
• Experience conducting medical case reviews for utilization and/or case management.
• Detail-oriented with an orientation to the application of data and metrics in managing health, quality, and program effectiveness.
• Leadership experience with demonstrated ability to build relationships, work with others, and lead people and project teams.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings.

Skills

• In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions.
• Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to manage patient care.
• Passion for population health, healthcare transformation, and improving the experience of people with mental health issues.
• Strong communication and facilitation skills with internal staff and external stakeholders.
• Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods, and accountable care and payment models.
• Experience conducting medical case reviews for utilization and/or case management.
• Detail-oriented with an orientation to the application of data and metrics in managing health, quality, and program effectiveness.
• Leadership experience with demonstrated ability to build relationships, work with others, and lead people and project teams.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings.

Benefits

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Please refer to the Pay section for details.

Schedule

This is a part-time non-benefited position with a maximum of 12 hours per week.

Skills and Attributes

• In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions.
• Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes.
• Passion for population health, healthcare transformation, and improving the experience of people with mental health issues.
• Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.
• Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods, and evolving accountable care and payment models.
• Experience conducting medical case reviews for utilization and/or case management.
• Detail-oriented with an orientation to the application of data and metrics in managing health, quality, and program effectiveness.
• Leadership experience with demonstrated ability to effectively build relationships, work with others, and lead people and project teams.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings.