Medical Director, Behavioral Health Position Available In Merrimack, New Hampshire

Job Description:

Your Role The Medical Management team ensures that Blue Shieldis on the cutting edge of medical, medication, and payment policyto accelerate the emergence of a value-based health care system inCalifornia. The Medical Director, Behavioral Health will report tothe Senior Medical Director, Behavioral Health. In this role youwill have core responsibilities in the areas of behavioral healthconcurrent review, pre- and post-service utilization review, andcollaboration with Clinical Care Managers. Our leadership model isabout developing great leaders at all levels and creatingopportunities for our people to grow – personally, professionally,and financially. We are looking for leaders that are energized bycreative and critical thinking, building and sustaininghigh-performing teams, getting results the right way, and fosteringcontinuous learning. Your Work In this role, you will: Reviewconcurrent, pre- and post-service behavioral health servicerequests and render decisions based on the member’s benefits,medical necessity, Blue Shield of California medical policy, FEP(Federal Employee Program) medical policy, as well as legal andregulatory requirements Medical decision and support for thebehavioral health review for all services currently requiringauthorization or review, facilitating appropriate use of allresources, including safe and timely discharges Engage intelephonic peer-to-peer discussions regarding current members invarious levels of care or who may be receiving other specializedservices. Therefore, the Medical Director must feel comfortable inclinical conversations with Blue Shield providers Train BSCutilization and care management staff which may include physicians,psychologists, nurses, social workers, and others as needed Performclinical reviews to support utilization management and fraud wasteand abuse case evaluations Participate with the quality managementfunction in the identification and analysis of medical informationto develop interventions to improve quality of care and outcomesfor our members Participate on projects and committees, asnecessary Your Knowledge and Experience Minimum 5 years directpatient behavioral health clinical care experience post residencyrequired Medical degree (M.D./D.O.) Completed residency inPsychiatry Maintain active, unrestricted California Medical Licenserequired; Maintain active, unrestricted Medical License in alladditional assigned states required Maintain Board Certification inPsychiatry through American Board of Psychology and Neurology(ABPN) or the American Osteopathic Board of Neurology andPsychiatry (AOBNP) required

Preferred Qualifications:

Recentinpatient psychiatric hospital experience (within the past fiveyears) Recent substance use disorders treatment experience (withinthe past five years) Well-versed with most areas of behavioralhealth services and conditions Show ability for rapid, accuratedecision-making, and enjoy care review, as well as theinvestigation and resolution of complex issues Experience with CPTcoding, medical claims review, hospital billing, and reimbursementDeep knowledge of MHPAEA (Mental Health Parity and Addiction EquityAct), SB855 and all regulatory and compliance requirements Managedcare experience supporting utilization management, case review,and/or quality improvement activities in behavioral healthExperience with ASAM, LOCUS, CALOCUS, and WPATH