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. Built on purpose, Cambia aims to create a person-focused and economically sustainable health care system. Join us to make a difference.

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 member care are aligned with organizational goals.
• Conducts case reviews requiring physician involvement and provides clinical expertise for behavioral health case management, prior authorizations, and appeals.
• Provides peer-to-peer consultations with providers to enhance the health care experience for members.

Requirements

• Licensed Physician with an MD or DO degree, active and unrestricted license in one of the four states.
• Board Certification in general psychiatry or child psychiatry, with preference for both.
• At least 3 years of clinical experience in behavioral health.
• Two years of health plan medical utilization management and/or case management experience.

Qualifications

• Deep knowledge of best practices for medical care of various behavioral health conditions.
• Experience working with hospitals, provider groups, or integrated delivery systems to manage patient care.
• A strong passion for patient care and healthcare transformation.
• Excellent communication and facilitation skills, including the ability to resolve issues and achieve optimal outcomes.
• Proven ability to develop and maintain positive relationships with community and provider partners.
• Knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods, and accountable care and payment models.
• Experience conducting medical case reviews for utilization and/or case management.

Skills and Attributes

• In-depth knowledge of medical care for a wide variety of behavioral health conditions.
• Demonstrated competency in managing 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.
• Leadership experience with proven 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.

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.

Schedule

• This is a part-time non-benefited position with a maximum of 12 hours per week.