Behavioral Health Medical Director Job at Blue Cross Blue Shield of Arizona (Phoenix)

Job Description

The Behavioral Health Medical Administrator (Medical Director) directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities. The position supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations, to advance timely access to high quality care and services, and to ensure that medical policies, procedures, and activities/actions of the division are consistent with the standards of good medical practice in the community and are in compliance with CMS, AHCCCS contract requirements and other regulatory agencies.

Job Responsibility

Directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities.
Supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations.
Provides physician leadership and medical oversight in the design, implementation and review of clinical services, best practices, care management, medical management and quality management.
Serves as liaison between the Medicaid Business Segment and medical and behavioral health practitioners at stakeholder and provider agencies.
Participates in aggregate and member-level clinical analyses for quality management, quality of care concerns, peer review, medical management, and utilization review processes.
Reviews and authorizes requests by providers and treatment coordinators for services or programs requiring prior authorization.
Participates in the design and implementation of best practices, clinical standards, protocols, and treatment guidelines.
Participates in credentialing, re-credentialing and competency processes for providers.
Assists care managers with care management of high risk/high-cost members.
Participates as a member or chair of internal and external committees.
Participates as a subject matter expert regarding grievance and appeals cases, provider and member complaints.
Partners with other plans and programs in the development, oversight and monitoring of shared services.
Participates in network development activities.
Review, advise on, and implement medical policies and other medical decision-making policies or procedures.
Represent BCBSAZ at professional organizations, act as liaison with individual health care professionals.
Conduct, as appropriate, appeals and peer review cases.
Provide written information to members and providers through letters and articles.
Work to ensure productive relationships with all customers, employers, members, and providers.
Provide leadership to staff and other professionals through clinical excellence, professional behavior and innovative thinking.
Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.
Identify opportunities to achieve administrative efficiencies while maintaining high quality service.
Maintain and promote effective working relationships to ensure teamwork in achieving corporate goals.
Contribute to departmental and cross-functional teamwork to achieve BCBSAZ goals.
Some travel may be required.
Perform all other duties as assigned.

Requirements

3 years of experience in a clinical setting
1 year of experience in physician leadership role, including quality review, utilization review, population health and other managed care functions
Medical Degree
Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)
Board Certification in general psychiatry, or adult and child/adolescent psychiatry, through the American Board of Psychiatry and Neurology
Requires knowledge and skills in state (Arizona) and federal behavioral health regulations, requirements for publicly funded services, delivery, operations, and licensure.
Knowledge of managed care concepts and practices
and emerging and best practices for adult & children’s integrated care programs.
Ability to use electronic word processing, email, and electronic database resources.
Excellent customer service and oral/written communication skills
Ability to multi-task projects and issues on fixed timelines.
Ability to clearly and effectively communicate, negotiate and advocate both verbally and in writing.
Ability to maintain confidentiality, privacy, and security of protected information.
Work effectively and efficiently both independently and as part of a team.

Nice to have

Experience with population health and/or medical management
Knowledge of NCQA accreditation standards for health plans
Knowledge of and/or experience with Medicaid or CMS dual special needs health plans.
Physician leadership, medical management, or population health coursework and training.
Familiarity with NCQA accreditation standards
Previous experience with AHCCCS and/or state Medicaid or D-SNP programs

Blue Cross Blue Shield of Arizona - All Job Offers

Select Country

Behavioral Health Medical Director

Job Description

Job Responsibility

Requirements

Nice to have

Looking for more opportunities?

Behavioral Health Medical Director

Associate Medical Director of PACE

Behavioral Health Medical Director

Medical Director - Behavioral Health

Executive Director for Integrated Student Counseling and Health Services

Medical Director of Population Health

Clinical Psychologist

Behavioral Health Billing Coordinator

Lead ABA Medical Biller

Our AI answers in your language