Medical Director, Behavioral Health (Remote in Iowa)
Company: Molina Healthcare
Location: Council Bluffs
Posted on: January 25, 2023
|
|
Job Description:
JOB DESCRIPTION Job Summary Molina's Behavioral Health function
provides leadership and guidance for utilization management and
case management programs for mental health and chemical dependency
services and assists with implementing integrated Behavioral Health
care management programs. - Knowledge/Skills/Abilities Provides
Psychiatric leadership for utilization management and case
management programs for mental health and chemical dependency
services. Works closely with the Regional Medical Directors to
standardized utilization management policies and procedures to
improve quality outcomes and decrease costs. - - --- - - - -
Provide regional medical necessity reviews and cross coverage --- -
- - - Standardizes UM practices and quality and financial goals
across all LOBs --- - - - - Responds to BH-related RFP sections and
review BH portions of state contracts --- - - - - Assist the BH MD
lead trainers in the development of enterprise-wide teaching on
psychiatric diagnoses and treatment --- - - - - Provides second
level BH clinical reviews, BH peer reviews and appeals --- - - - -
Supports BH committees for quality compliance. --- - - - -
Implements clinical practice guidelines and medical necessity
review criteria --- - - - - Tracks all clinical programs for BH
quality compliance with NCQA and CMS --- - - - - Assists with the
recruitment and orientation of new Psychiatric MDs --- - - - -
Ensures all BH programs and policies are in line with industry
standards and best practices --- - - - - Assists with new program
implementation and supports the health plan in-source BH services
--- - - -Additional duties as assigned Job Qualifications REQUIRED
EDUCATION: --- Doctorate Degree in Medicine (MD or DO) with Board
Certification in Psychiatry REQUIRED EXPERIENCE: --- 2 years
previous experience as a Medical Director in clinical practice ---
3 years' experience in Utilization/Quality Program Management ---
2+ years HMO/Managed Care experience --- Experience demonstrating
strong management and communication skills, consensus building and
collaborative ability, and financial acumen. --- Knowledge of
applicable state, federal and third-party regulations Required
License, Certification, Association Active and unrestricted State
Medical License, free of sanctions from Medicaid or Medicare. -
Preferred 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. PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and
-temperature are adequate. -Work is -generally -performed in an
-office -environment in -which -there is -only -minimal -exposure
to unpleasant and/or hazardous -working conditions. -Must -have the
ability -to sit for long -periods. -Reasonable accommodations -may
be -made to -enable individuals with disabilities -to -perform -the
-essential function. #PJHPO 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. Pay Range: $161,914.25 - $315,732.79 a year* *Actual
compensation may vary from posting based on geographic location,
work experience, education and/or skill level.
Keywords: Molina Healthcare, Council Bluffs , Medical Director, Behavioral Health (Remote in Iowa), Healthcare , Council Bluffs, Iowa
Click
here to apply!
|