Position Summary
The Behavioral Health Medical Director is a key physician leader providing organizational leadership in the operational areas of utilization review, case management, and related policy and practice initiatives. He/she will serve as a lead physician on the Behavioral Health Medical Management team working closely with the Chief Medical Officer, other physician reviewers, the Director of Medical and Quality Management, Manager of Utilization Management, Manager of Case Management, Manager of Quality Management, Manager of Mommy & Me Program, Manager of Behavioral Health and the Pharmacy Consultant.

Principal Accountabilities
• Assist in the development and implementation of behavioral health policies as they relate to health services utilization.
• Maintain compliance with the Centers for Medicare and Medicaid Services (CMS), NCQA and state regulations.
• Directs the efforts of the utilization review, case management, and precertification function to accomplish objectives within policy and budget. Performs daily behavioral health reviews.
• Assist in the development and implementation of the utilization management and provider education functions within Medical Management regarding behavioral health.
• Work collaboratively with the Chief Medical Officer to build credibility by actively creating linkages with the provider community; working with community Behavioral Health leaders to develop more cost-effective means for care management; regularly communicate with providers regarding plan goals, and getting buy-in to support successful policy and program implementation.
• Participate with the quality management function in the identification and analysis of medical information in order to develop interventions to improve quality of care and outcomes for our members.
• Provide timely response and feedback to other departmental inquiries and requests; promote continuous quality improvement throughout the organization by working with the Medical Management team to analyze current operations.
• Assist in the network development/relations and provider recruitment functions as necessary.
• Adhere to confidentiality codes at all times, respecting the dignity and privacy of all members, providers, and employees.
• Serve on various committees as assigned.
• Demonstrate a commitment to and an understanding of the Affirmative Action Plan.
• Perform other related duties as assigned by the Chief Medical Officer.

Position Qualifications/Requirements
Education and Training
A medical degree with Psychiatry specialty (M.D. or D.O.)

Experience
• A minimum of five (5) years of behavioral health and general management experience in a managed care environ- ment is preferred.
• Prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed Care Plan preferred.
• Utilization management experience preferred. Minimum five years of progressive business experience.

Licenses, Registrations or Certifications
• Board Certified Psychiatrist
• Must possess a current, active, state license to practice medicine without restrictions.

Please direct all inquiries to Dave Mara at 804.527.1905.