Behavioral Health Medical Director

Position Purpose

The Behavioral Health Medical Director provides medical leadership to specific health plan or LOB to include overseeing physician review, utilization review/quality assurance, directing case management, developing and implementing medical policies and standards, evaluating new technologies and treatments. In this role, you will identify trends in medical management and proactively aid in setting direction to improve these.

Description

Location: This position is full-time (40-hours/week) Monday-Friday REMOTE in South Carolina. You will be required to come on-site to the 4101 Percival Road, Columbia, SC 29229 location twice monthly.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You’ll Do

• Provides leadership and medical support on medical and regulatory matters.
• Identifies trends in medical and pharmacy costs, utilization trends, and proactively makes recommendations and initiates solutions to impact these.
• Provides leadership to clinical team and operations in order to increase compliance, improve efficiency, and increase communication.
• Acts as resource for providers, staff, part time medical reviewers, and as requested, customers, on issues concerning medical policies and regulations.
• Provides clinical support to Payment Integrity Unit(s) to analyze abuse patterns and recommend solutions.
• Works with staff and other leadership in developing ideas related to quality initiatives, good clinical support, and outreach to the network.
• Responsible for physician review (UM, Appeals, CM) - reviews physician and provider practice pattern analysis and other statistical data.
• Conducts research into new or controversial medical procedures and technology.
• Educates staff, network providers, and medical community on various aspects of medical policy and program administration.

To Qualify For This Position, You'll Need

• The Following Required Education: Doctorate Degree - Medical Doctor (MD) with current active medical license, without restriction. If Behavioral Health, Medical Director – Doctor of Psychiatry with current active medical license, without restriction.
• The Following Required Work Experience: 8 years post graduate experience in direct patient care.
• The Following Required Skills and Abilities: Managed care knowledge and experience required. Working knowledge of regulatory and accreditation entities, i.e., URAC, NCQA, DOI, and DOL standards. Excellent verbal and written communication skills. Excellent customer service, organizational, and presentation skills. Good judgment skills. Proficiency in spelling, punctuation, and grammar. Ability to persuade, negotiate, or influence others, represent our company well. Ability to work as a team member as well as a leader.
• The Following Required License and Certificates: Active, unrestricted medical license from the United States and in the state of hire and current board certification in a recognized specialty. We Prefer That You Have The Following Doctorate Degree - Medical Doctor (MD) with current active South Carolina medical license, without restriction. Completion of a Psychiatry residency with preference for specialty in Child and Adolescent Psychiatry. Strong knowledge of Medicaid programs, regulations and compliance. Ability to develop and maintain positive relationships with peers, enterprise, customers, and partners. Demonstrated ability to drive continuous improvement and cost reduction. Ability to effectively collaborate with cross-functional teams. Executive level presentation skills. Experience working with the SC Department of Health and Human Services.

Our Comprehensive Benefits Package Includes

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

Pay Range Information

Raise Minimum $206,111.00 Raise Midpoint $309,767.00 Raise Maximum $413,523.00

Pay Transparency Statement

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

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