Medical Director - Behavioral Health

The Medical Director for Behavioral Health is responsible for implementing effective utilization review, care management and other clinical practice strategy development and improvement initiatives as assigned by the Vice President of Behavioral Health. Other responsibilities may include network development, benefit management and design, and providing clinical and strategic direction in support of CareOregon delivery system improvements. This position may be assigned to lead medical management initiatives for the organization including clinical quality in the provider network, as well as utilization, quality, case management and disease management operations, monitoring and results, in the business areas of integration and behavioral health. This position has a matrix reporting relationship to the Senior Medical Director.

Essential Responsibilities

• Develop, recommend, implement, execute and manage effective programs in all clinical areas of behavioral health and integration.
• Work with colleagues to develop, implement and manage clinical and wellness programs to address the needs of members.
• Provide psychiatric consultation to Care Management activities throughout the organization.
• Perform benefit determinations, appeals and quality of care investigations in behavioral health areas, as assigned by the VP of Behavioral Health and Senior Medical Director.
• Partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems.
• Work with local CCO and network clinical leadership to develop a high performing system of care with measurable outcomes.
• Collaborate with diverse multi-disciplinary teams within and outside the organization; grow and leverage community partnerships.
• Oversee the organizational clinical strategy to address substance use disorders.
• Participate in development of value-based payment models in the BH networks.
• Implement, direct and oversee utilization, case, disease, and/or quality management programs.
• Develop and implement programs for educating participating physicians regarding quality management and utilization management issues.
• Represent the health plan in applicable activities including medical and other professional organizations.
• Participate in activities that enhance CareOregon’s image within the community.
• Serve as a representative and medical spokesperson for the plan in support of service area expansions, contract negotiations and other provider expansion activities.
• Serve as an advanced technical resource for clinical and non-clinical staff.
• Propose and implement process improvements.
• Meet deadlines for completion of workload.
• Maintain agreed upon work schedule.
• Demonstrate cooperation and teamwork.
• Provide cross-training on specific job responsibilities.

Experience and/or Education

Required

• Doctor of medicine or osteopathy in the specialty area of pediatric/adolescent psychiatry
• Possession of or ability to obtain an unrestricted license to practice in Oregon
• Minimum 5 years of relevant and progressive experience in a managed care organization or practice setting, preferably with Medicaid, including or following strong clinical practice activity

Preferred

• Minimum 4 years’ experience in a supervisory position
• Board certification

Knowledge, Skills and Abilities Required

Knowledge

• Medical policy knowledge and skills as related to quality, case and disease management and credentialing activities
• Thorough knowledge of the adult mental health system of care, including state hospital, criminal justice, and involuntary commitment processes
• Working knowledge of children’s system of care and Wraparound program
• Clinical knowledge of the management of diverse medical problems
• Proficient knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare, and commercial insurance
• Effective understanding of managed care operations

Skills and Abilities

• Excellent communication and collaboration skills for work with network providers and internal employees
• Ability to motivate and bring individuals and teams together and meld into a cohesive unit
• Ability to work effectively as part of a cross-functional team and foster an environment where change is embraced and supported
• Ability to deal with issues and problems systemically
• Proven ability to work as an integral part of a team
• Ability to plan, set priorities, delegate effectively and utilize time efficiently
• Skill in applying innovative and creative approaches to improve health care delivery
• Demonstrated use of quality management techniques in a large, organized managed care setting
• Demonstrated commitment to improving access and quality of care to the underserved and uninsured
• Appreciation of cultural diversity and the needs of serving a diverse patient population
• Familiarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studies
• Awareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement concepts
• Demonstrated comfort, enjoyment and facility to continuously interact with professional colleagues individually and in groups concerning health management, treatment and health data
• Results-oriented decision-maker with the ability to balance diverse priorities
• High degree of initiative and motivation along with the ability to effectively support and collaborate with others to achieve business objectives
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

• Work Environment(s): Indoor/Office
• Member/Patient Facing: No
• Hazards: May include, but not limited to, physical and ergonomic hazards.
• Equipment: General office equipment and/or mobile technology
• Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
• Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.