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Job description
Your Role
The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
Medical degree (M.D./D.O.) required
Completed an ACGME accredited residency in Psychiatry required
Minimum 5 years direct patient behavioral health clinical care experience post residency required
Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required
Recent inpatient psychiatric hospital experience (within the past five years)- preferred
Recent substance use disorders treatment experience (within the past five years) preferred
Well-versed with most areas of behavioral health services and conditions
Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues
Experience with CPT coding, medical claims review, hospital billing, and reimbursement is strongly preferred
Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements is strongly preferred
Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health is strongly preferred
Experience with ASAM, LOCUS, and CALOCUS is strongly preferred
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
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Worksite address
san diego, CA, 92189, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.