Medical Director, Behavioral Health Job at Molina Healthcare, Chandler, AZ

RWxNcUE5QXZzT3dsbHA5R0c3bFA1ZDExblE9PQ==
  • Molina Healthcare
  • Chandler, AZ

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. 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. \#PJHS \#LI-AC1 Pay Range: $161,914.25 - $315,733 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Job Tags

Work experience placement,

Similar Jobs

PAR Technology

QA Engineer Salesforce Job at PAR Technology

 ...flexible depending on your experience Experience working with Sales Force CRM systems in a technical capacity 2+ years performing QA for medium to large Salesforce organizations Experience with Sales Cloud required and CPQ is preferred Familiarity with Agile... 

Ernesto's

Pastry Chef de Partie Job at Ernesto's

 ...Ernestos seeks experienced pastry cooks to join Ernesto's team. We are looking forprofessionals with a passion for service to join our...  ...kitchen staff Answer, report and follow executive or sous chefs instructions Clean up station and take care of leftover food... 

Get It - Healthcare

RN Triage Nurse - Remote Job at Get It - Healthcare

We are excited to welcome experienced Registered Nurses (RNs) to join our growing, fast-paced telephone triage team. This is a fantastic opportunity for those who enjoy working in a dynamic environment and are looking to make a positive impact in both pediatric and adult... 

Evolution Hospitality

The Fort Sutter Hotel Sacramento, Tapestry Collection - Housekeeper Job at Evolution Hospitality

 ...our lobby bar, Four Palms. Fresh bites and yummy drinks are available from 7a-9p daily. About Evolution Hospitality As the dedicated lifestyle vertical at Aimbridge, Evolution Hospitality creates distinct lifestyle experiences and drives performance throughout our curated... 

Tekdoors

Pega Developer - Contract W2 - 10+ Yrs Job at Tekdoors

 ...Pega Developer 10+ Yrs Contract W2 12 Months Jersey City, NJ Onsite(Hybrid) Must have 3 years of experience POST PEGA Lead System Architect Certification Minimum of 7 years work experience Post PEGA SSA Certification. Very strong IT technical...