Behavioral Health Medical Director - Psychiatrist - California Medicaid (Part-Time)

Location: This role enables associates to work virtually full-time, with the exception of required in-person meetings. Candidates must live in California and be within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law.

Schedule

This is a part-time position working 25 hours a week. The hours are flexible, but you will be expected to work over 5 days a week with no weekend or holiday expectations.

Responsibilities

• Oversee California Medicaid behavioral health services with a primary focus on conducting utilization management (UM) reviews across all levels of care.
• Monitor and analyze behavioral health trends within the health plan.
• Serve as a clinical advisor and thought leader through ongoing collaboration with health plan partners.
• Provide support to behavioral health UM and case management teams beyond individual case reviews.
• Offer cross-coverage support for other medical directors as needed.
• Support clinicians to ensure timely and consistent responses to members and providers.
• Provide guidance for clinical operational aspects of a program.
• Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients' office visits.
• Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers.
• Serve as a resource and consultant for other areas of the company.
• Represent the company to external entities and/or serve on internal and/or external committees.
• Chair company committees.
• Interpret medical policies and clinical guidelines.
• Develop and propose new medical policies based on changes in healthcare.
• Lead, develop, direct, and implement clinical and non-clinical activities that impact healthcare quality, cost, and outcomes.
• Identify and develop opportunities for innovation to increase effectiveness and quality.

Requirements

• Requires MD or DO and Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
• Must possess an active unrestricted medical license to practice medicine or a health profession in the state of California.
• Must be located in a state or territory of the United States when conducting utilization review or appeals consideration, unless expressly allowed by law.
• Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing healthcare is required.
• Additional experience may be required by State contracts or regulations if the Medical Director is fulfilling a role required by a State agency.

Preferred Qualifications

• Child and Adolescent, Addiction Psychiatry/Medicine board certification preferred.

Pay

The salary range for this specific position in California is $178,135 to $290,437.50. The salary offered is based on a number of legitimate, non-discriminatory factors set by the Company.

Benefits

• Comprehensive benefits package, including medical, dental, vision, short and long-term disability benefits, and 401(k) contribution with company match.
• Incentive and recognition programs.
• Equity stock purchase plan.
• Paid holidays and Paid Time Off (PTO).
• Life insurance, wellness programs, and financial education resources.