Medical Director, Behavioral Health

Molina Healthcare • South Carolina, South Carolina • 3h ago

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs.

Facilitates behavioral health-related regional medical necessity reviews and cross coverage.

Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses.

Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts.

Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment.

Provides second level behavioral health clinical reviews, peer reviews and appeals.

Supports behavioral health committees for quality compliance.

Implements behavioral health specific clinical practice guidelines and medical necessity review criteria.

Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS).

Assists with the recruitment and orientation of new psychiatric medical directors.

Ensures all behavioral health programs and policies are in line with industry standards and best practices.

Assists with new program implementation and supports for health plan in-source behavioral health services.

Required Qualifications

At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience.

Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice.

Board Certification in Psychiatry.

Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.

Ability to work cross-collaboratively within a highly matrixed organization.

Strong organizational and time-management skills.

Ability to multi-task and meet deadlines.

Attention to detail.

Critical-thinking and active listening skills.

Decision-making and problem-solving skills.

Strong verbal and written communication skills.

Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.

Preferred Qualifications

Experience with utilization/quality program management.

Managed care experience.

Peer review experience.

Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $186,201.39 - $363,092.71 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

Medical Assistant

CVS Health • Greenville, SC • 3h ago

Hospital & Medical

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate...

3h ago

Go to Apply

Medical Assistant

CVS Health • Greenville, SC • 3h ago

Hospital & Medical

3h ago

Go to Apply

Medical Director, Behavioral Health

Molina Healthcare • Charleston, SC • 3h ago

Hospital & Medical

3h ago

Go to Apply

Registered Nurse - ED Market Float

Novant Health • Hilton Head Island, SC • 3h ago

Hospital & Medical

What We Offer Novant Health Hilton Head Hospital is seeking Market Float ED RNs! Sign-on bonus available up to $25,000 and Relocation allowance available! Market Float Rate Incentive Status: Full Time Shift: Days/ Mids r...

3h ago

Go to Apply

Pharmacy Operations Manager

Walgreens • Lexington, SC • 4h ago

Hospital & Medical

Job Description: Where state and federal laws/regulations allow, accountable for performing day-to-day non-clinical pharmacy operations, administrative activities; Ensures efficient pharmacy workflow and a positive patie...

4h ago

Go to Apply

Pharmacy Operations Manager

Walgreens • Summerville, SC • 4h ago

Hospital & Medical

4h ago

Go to Apply

Pharmacy Operations Manager

Walgreens • Lexington, SC • 4h ago

Hospital & Medical

4h ago

Go to Apply

Administrative LPN/LVN

Sevita • Greenville, SC • 8h ago

Hospital & Medical

Mentor Community Services , a part of the Sevita family, provides community-based services for individuals with intellectual and developmental disabilities. Here we believe every person has the right to live well, and ev...

8h ago

Go to Apply

Health System Specialist

Veterans Affairs, Veterans Health Administration • Columbia, SC • 18h ago

Hospital & Medical

Summary This position reports to the Ambulatory Care Operations Director (ACOD) / Group Practice Manager (GPM). The primary purpose of the position is to provide assistance and support to the ACOD/GPM and to all ambulato...

18h ago

Go to Apply

Licensed Practical Nurse

PruittHealth • Ridgeway, SC • 20h ago

Hospital & Medical

LICENSED PRACTICAL NURSE Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the health and safety of all our nurses...

20h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.