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 integrated utilization management.
• Oversees the development of effective operational policies, procedures, and standards for an integrated behavioral health program.
• Makes determinations on utilization management and quality improvement policies.
• Collaborates with the Executive Medical Director of Behavioral Health, leads/participates in teams for medical policy reviews and development, and discusses review determinations with providers to promote understanding of utilization management and quality improvement policies.
• Stays abreast of industry, medical, and technology trends, identifies and communicates new opportunities to enhance outcomes and the organization's reputation, and collaborates to implement actions to reduce medical cost trend.

Requirements

• 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

Qualifications

• What You Bring to Cambia:
• 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

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 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

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. Associate Medical Director Oregon, Washington, Utah, and Idaho: The expected hiring range is $217,600 - $294,400, the full salary range is $204,000 - $333,000 and the bonus target is 25%. North Dakota: The expected hiring range is $217,171.97 - $293,820.91 and the full salary range is $192,827.15 - $318,165.72. Medical Director Oregon, Washington, Utah, and Idaho: The expected hiring range is $238,850 - $323,150, the full salary range is $224,000 - $366,000 and the bonus target is 30%. North Dakota: The expected hiring range is $252,506.91 - $341,626.99, the full salary range is $224,201.29 - $369,932.61 and the bonus target is 20%.