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 – all in service of creating 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 met.
• 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 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.

What You Will Do At Cambia

• Completes Behavioral Health utilization management reviews, including PA, appeals, and post-service.
• Develops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management.
• Operational Leadership and Oversight: Oversees the development of effective operational policies, procedures, and standards for an integrated behavioral health program, monitors utilization and results, and implements process or system changes as needed.
• Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
• Collaboration and Communication: 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.
• Industry Trends and Opportunities: 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.
• Other roles as assigned.

Pay and 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.
• Medical Director positions in 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%.
• Medical Director positions in 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%.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy, and team spirit always shine through.

Why Join the Cambia Team?

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

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.