Associate Medical Director BH or UM Medical Director

Company: Cambia Health Solutions, Inc
Location: Renton
Posted on: August 31, 2024

Job Description:

Associate Medical Director Behavioral Health or UM Medical DirectorWork from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia's dedicated team of physicians are living our mission to make health care easier and lives better. As a member of the Utilization Management team, our Associate Medical Director Behavioral Health and UM Medical Directors provides leadership, and clinical oversight for behavioral health operations across all lines of business within the health plan, with a primary focus on behavioral health utilization management. Partners with leaders and staff across the organization to ensure policies, programs and strategies related to our members. Conducts case reviews requiring physician involvement and/or provides clinical expertise to others related to behavioral health case management, prior authorizations and appeals. Provides peer-to-peer consultations with providers - all in service of creating a person-focused health care experience.Are you a motivated and experienced medical professional looking for a new challenge? Do you have a passion for patient care and want to make a big difference in healthcare? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications:

• Licensed Physician with an MD or DO degree
• Active, unrestricted license to practice medicine in one or more of our 4 states.
• Board Certification in general psychiatry or child psychiatry required with preference for being board certified in both.
• Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review.
• At least 3 years clinical experience.
• Two years health plan medical utilization management and/or case management experience.
• Equivalent combination of education and experience.
• Must be located in one of our four states.Skills and Attributes:
  • In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions.
  • Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes.
  • Passion for population health, healthcare transformation and improving the experience of people with mental health issues.
  • Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.
  • Proven ability to develop and maintain positive working relationships with community and provider partners.
  • Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods and evolving accountable care and payment models is preferred.
  • Experience conducting medical case reviews for utilization and/or case management is strongly preferred.
  • Detail-oriented with orientation to the application of data and metrics in managing health, quality and program effectiveness.
  • Leadership experience with demonstrated ability to effectively build relationships, work with others and lead people and project teams.What You Will Do at Cambia:
    • Develops and Implements Behavioral Health Policies and Programs: Assists in developing high-quality, market-competitive behavioral health medical policies and programs, and provides leadership in developing short and long-range plans, goals, and objectives for integrated utilization management.
    • Operational Leadership and Oversight: Oversees the development of effective operational policies, procedures, and standards for an integrated behavioral health program, monitors utilization and results, and implements process or system changes as needed.
    • Subject Matter Expert and Clinical Leadership: Serves as a subject matter expert on behavioral health, provides medical advice, oversight, and leadership for staff, and ensures members receive safe, effective, and cost-efficient services.
    • Collaboration and Communication: Collaborates with the Executive Medical Director of Behavioral Health, leads/participates in teams for medical policy reviews and development, and discusses review determinations with providers to promote understanding of utilization management and quality improvement policies.
    • Industry Trends and Opportunities: Stays abreast of industry, medical, and technology trends, identifies and communicates new opportunities to enhance outcomes and the organization's reputation, and collaborates to implement actions to reduce medical cost trend.
    • Other roles as assigned.#LI-Remote

Keywords: Cambia Health Solutions, Inc, Renton , Associate Medical Director BH or UM Medical Director, Executive , Renton, Washington