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. Work from home within Oregon, Washington, Idaho or Utah.

Responsibilities

• Builds a career with purpose by joining our Cause to create a person-focused and economically sustainable health care system.
• Provides leadership, clinical oversight, and clinical expertise for behavioral health operations across all lines of business within the health plan.
• Collaborates with leaders and staff across the organization to ensure policies, programs, and strategies related to our members.
• Conducts case reviews requiring physician involvement and/or provides clinical expertise to others related to behavioral health case management, prior authorizations, and appeals.
• Provides peer-to-peer consultations with providers to create a person-focused health care experience.

Qualifications

• Licensed Physician with an MD or DO degree, active, unrestricted license to practice medicine in one or more of our 4 states.
• Board Certification in general psychiatry or child psychiatry required with preference for being board certified in both.
• At least 3 years clinical experience.
• Two years health plan medical utilization management and/or case management experience.
• Equivalent combination of education and experience.
• Must be located in one of our four states.

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.
• Proven ability to develop and maintain positive working relationships with community and provider partners.
• 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 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.

Pay

• 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.

About Cambia

Cambia’s dedicated team of physicians lives our mission to make health care easier and lives better. As a member of the Utilization Management (UM) team, our Associate Medical Director BH and UM Medical Directors provides leadership, and clinical oversight for behavioral health operations across all lines of business within the health plan, with a primary focus on behavioral health utilization management.

Benefits

• Medical, dental, and vision coverage for employees and their eligible family members, including mental health benefits.
• An annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• A market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.