Medical Director, Behavioral Health (Based in NM)
Company: Molina Healthcare
Location: Albuquerque
Posted on: April 16, 2024
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Job Description:
JOB DESCRIPTION
Job Summary
Molina's Behavioral Health function provides leadership and
guidance for utilization management and case management and quality
programs for mental health and chemical dependency services and
assists with implementing integrated Behavioral Health care
management programs.
** Based in New Mexico
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
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Job Qualifications
REQUIRED EDUCATION:
--- Doctorate Degree in Medicine (MD or DO) with Board
Certification in Psychiatry (Child/Adolescent)
REQUIRED EXPERIENCE:
--- 5 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 (New Mexico) 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-JR1 Pay Range: $161,914.25 - $315,732.79 / ANNUAL
*Actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level.
Keywords: Molina Healthcare, Albuquerque , Medical Director, Behavioral Health (Based in NM), Executive , Albuquerque, New Mexico
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