Description: Job SummaryBring your clinical psychiatric experience, leadership & initiative to the Behavioral Health function of the Utah & Idaho health plans. The BH Medical Director will conduct utilization reviews, determine strategic direction of BH activities and develop recommendations for integrated mental health and chemical dependency programs and outreach statewide. What you will do\\: Provide Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Indirectly supervises Health Plan Psychiatric Medical Directors in implementing integrated Behavioral Health care management programs. Work closely with the MHI VP of Behavioral Health and National Medical Directors to develop standardized utilization management policies and procedures to be implemented enterprise-wide that will improve quality outcomes and decrease costs. Develop scorecard benchmarks for Behavioral Health (BH) clinical staff productivity. Standardize UM practices and quality and financial goals across all LOBs. Respond to BH-related RFP sections and review BH portions of state contracts. Work with trainers to develop and provide enterprise-wide teaching on psychiatric diagnoses and treatment. Write, refine, and approve BH Policies and Procedures for utilization and case management. Provide second level BH clinical reviews, BH peer reviews and appeals. Facilitate BH committees for quality compliance. Work with VP Pharmacy to establish standard Psychiatric formulary. Implement clinical practice guidelines and medical necessity review criteria. Track all clinical programs for BH quality compliance with NCQA and CMS. Participate in the recruitment, placement and orientation of new HP Psychiatric MDs. Ensure all BH programs and policies are in line with industry standards and best practices. Assist with new program implementation and supports the health plan in-source BH services. Assist with reviewing and evaluating BH vendors.
Qualification: Job QualificationsRequired EducationDoctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry Required Experience 2 years previous experience as a Medical Director. 3 years experience in Utilization/Quality Program Management. 5+ years clinical practice. 5+ years HMO/Managed Care experience. Current clinical knowledge. Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen. Knowledge of applicable state, federal and third party regulationsRequired License, Certification, AssociationActive and unrestricted State Medical License, free of sanctions from Medicaid or Medicare. Preferred EducationN/APreferred Experience Peer Review, medical policy/procedure development, provider contracting experience. Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.To all current Molina employees\\: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.#CB-MHI
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