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 to practice medicine in one of the four states.
• 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.
• 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 evolving accountable care and payment models.
• Experience conducting medical case reviews for utilization and/or case management.

Skills and Attributes

• Detail-oriented with a focus on data and metrics in managing health, quality, and program effectiveness.
• Leadership experience with the 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

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

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 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 is preferred.

Experience conducting medical case reviews for utilization and/or case management is strongly preferred.

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 highly desired.