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 member care are aligned with organizational goals.
• Conducts case reviews requiring physician involvement and 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 or more of the following states: Oregon, Washington, Idaho, or Utah.
• Board Certification in general psychiatry or child psychiatry required with preference for 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 the four states mentioned.

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.
• 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.
• 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.

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.
• 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.
• 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.

Benefits

The expected hiring range varies based on the candidate's work location. The expected hiring range for Associate Medical Director positions in Oregon, Washington, Utah, and Idaho is $217,600 - $294,400, with a full salary range of $204,000 - $333,000 and a bonus target of 25%. For 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. The expected hiring range for Medical Director positions in Oregon, Washington, Utah, and Idaho is $238,850 - $323,150, with a full salary range of $224,000 - $366,000 and a bonus target of 30%. For North Dakota, the expected hiring range is $252,506.91 - $341,626.99, with a full salary range of $224,201.29 - $369,932.61 and a bonus target of 20%.

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. 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%.

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.

Compensation

Award-winning wellness programs that reward you for participation. Employee Assistance Fund for those in need. Commute and parking benefits.

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).
• Employee Assistance Fund for those in need.
• Commute and parking benefits.