Medical Director, Behavioral Health (5 HR / WK)
PacificSource

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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: The behavioral health medical director is part of the leadership team that oversees the behavioral health clinical programs for our enrollees. The behavioral health medical director will collaborate closely with other health plan leaders to include the behavioral health director to integrate the day-to-day administration and strategic management of behavioral and physical health services. This position may include the development and/or implementation of programs to improve quality, cost and outcomes. The behavioral health medical director will be instrumental as a clinical/strategic advisor to enhance clinical operations.

Essential Responsibilities:

• Ensures the provision of quality and clinically sound behavioral health care services to all enrollees by associates and providers
  
• Serves as medical advisor for all behavioral health clinically related activities
  
• Performs clinical case reviews in conjunction with the utilization management and appeals and grievances departments to include review for medical necessity, peer to peer discussions, benefit extensions, appeals, administrative law judge hearings and denial of behavioral health services
  
• Performs clinical case reviews in conjunction with care/case management and assists in the development of individualized care plans for enrollees.
  
• Works closely with an interdisciplinary team to ensure behavioral health management and quality management programs are meeting contractual obligations
  
• Identifies and works to implement evidence-based practice guidelines throughout the provider network
  
• Oversees the quality of clinical care for network and non-network providers
  
• Engages the provider network in continuous quality improvement through the diffusion of practice standards, and through internal quality assurance programs that measure network provider performance.
  
• Represent the organization to external entities and/or serve on internal and/or external committees
  
• Maintains familiarity with federal, state, and local regulations that may pertain to medical and clinical operations
  
• Provides leadership in the development and implementation of medical and organizational policy as it relates to behavioral health
  
• Serve as Chair of Behavioral Health Sub-Committee of the Clinical Quality and Utilization Management Committee and member of the Clinical Quality and Utilization Management Committee (Clinical Psychiatrist participant).
  
• Assist with credentialing review of Behavioral Health. Assist Provider Network staff with BHS Panels, contracting OTA's Access and Quality of Behavioral Health Services.
  
• Other duties as assigned
  

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
  
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  

SUCCESS PROFILE

Work Experience: MD or DO required. Clinical and administrative experience in Behavioral Health Services, as well as utilization and management with hospitals, medical clinics and health insurance plans. Experience in an integrated health care system and comprehensive knowledge of business principles and techniques of administration, organization and management; preferred experience includes:

• Strategic and operational planning
  
• Healthcare economics and contracting
  
• Personnel administration
  
• Federal and state healthcare reform
  
• Financial and cost analysis
  
• Trends in the healthcare industry
  
• Delivery system transformation including Behavioral Health integration into Primary Care Medical Homes (PCMHs)
  
• Behavioral Health utilization and case management applying clinical criteria and evidenced based guidelines.
  

Education, Certificates, Licenses: Board certification in psychiatry is required. Unrestricted license to practice medicine in the state of Oregon is required with ability to obtain licensure in other states as needed by the organization (WA, ID, MT).

Knowledge: Comprehensive knowledge of business principles and techniques of administration, organization, and management to include an in-depth understanding of the key business issues that exist in the healthcare industry. These include, but are not limited to quality improvement including, Lean methodology, healthcare economics, personnel administration, financial and cost analysis, trends in the healthcare industry. Excellent understanding of all areas of Behavioral Health treatment, and care. Excellent understanding of the insurance industry and risk factors and how they relate to the PacificSource organization. Remain current in the medical field. Basic computer skills including experience with Microsoft Outlook, Word and Excel. Ability to use audio-visual equipment.

Competencies

• Building Trust
  
• Building a Successful Team
  
• Aligning Performance for Success
  
• Building Customer Loyalty
  
• Building Strategic Work Relationships
  
• Continuous Improvement
  
• Decision Making
  
• Facilitating Change
  
• Leveraging Diversity
  
• Driving for Results
  

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 2% of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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