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 clinical decisions and provides oversight for staff, ensuring members receive safe, effective, and cost-efficient services.
• Collaborates with the Executive Medical Director of Behavioral Health, leading/participating in teams for medical policy reviews and development.
• Communicates with providers to discuss review determinations and promote understanding of utilization management and quality improvement policies.
• Stays informed on industry trends, identifies new opportunities, and collaborates to implement actions that reduce medical cost trends.

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.
• Must be located in one of our four states.

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 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.

Skills and Attributes

• 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.

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%.

Schedule

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