Medical Director - Behavioral Health

About the role

The position involves providing physician leadership and support to Capital's behavioral health program. It requires collaboration with internal and external stakeholders to drive Triple Aim outcomes and improve access and availability of care.

Responsibilities

• Collaborates in the development and evolution of Capital’s BH program and strategy.
• Provides oversight, guidance, consultation, and expertise to Capital’s BH clinical operations.
• Reviews data to identify trends and provide feedback on medical necessity criteria and policies.
• Collaborates with key external stakeholders to drive Triple Aim outcomes.
• Provides clinical leadership to the development and evolution of BH strategies.
• Champions provider practice transformation in support of value-based delivery models.
• Reviews and analyzes data to drive improvements in member health, experience of care, and medical costs.
• Supports organizational accreditation efforts and regulatory review processes.

Qualifications

• A minimum of five years of clinical experience, post-residency, including both inpatient and outpatient mental health and/or substance use disorder.
• A minimum of eight years of experience in health care, with an emphasis on analysis and process optimization.
• A managed care organization or health insurance plan experience is preferred.
• An MD or DO degree, with appropriate board certification.
• A current unrestricted license in Pennsylvania as an MD or DO.
• Current coverage by, or eligibility to be covered by, medical liability insurance.
• A current valid Pennsylvania drivers' license.

Skills

• PC literacy and ability to perform electronic research and respond to electronic requests.
• A team-oriented attitude with the ability to work and interact with all levels both within and outside of CBC.
• Effective multitasking under pressure, meeting deadlines, and delivering high-quality work.
• The ability to convey complex or technical information in a manner that others can understand.
• Demonstrated organizational and time management skills.
• A self-motivated individual who works independently and is highly accountable.
• Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
• Experience driving results to completion while managing multiple projects and priorities competing for resources.
• The ability to complement leadership and other team members in their responsibilities and roles.

Benefits

Capital Blue Cross offers a comprehensive benefits package including Medical, Dental & Vision coverage, a Retirement Plan, generous time off, an Incentive Plan, Tuition Reimbursement, and more. The company also values its employees' health and wellbeing, offering opportunities for professional and personal growth through training and continuing education.