Medical Director, Behavioral Health (Hybrid)

Resp & QualificationsPURPOSE:The Behavioral Health Medical Director oversees all activities of utilization review, care management and quality to determine the medical effectiveness related to behavioral health and substance use. The critical responsibility will be the management of care delivery in a cost effective and quality assured system that will assist the organization to achieve its corporate mission of serving the behavioral health needs of members.ESSENTIAL FUNCTIONS:

Ensure that the provision of behavioral health care service to the membership is compliant with the medical policies and standards. Participate in medical necessity reviews, including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals.

The Behavioral Health Medical Director will propose policies and standards for review and resolution to the committee and communicate these policies and standards to physicians participating in the network.

Oversees all activities of behavioral health utilization review, care management and quality to determine the medical effectiveness of proposed treatments and approve care management plans.

Collaborates with Network Management in improving access to care.

Represents company with provider community, professional organizations, legislative work groups and governmental agencies.

Responsibility for after-hours function.

QUALIFICATIONS:Education: Medical Degree from an accredited medical school, completion of an American residency program.Experience:

5 years minimum of clinical practice experience in the field of psychiatry

2 years managed care experience with Accreditation experience.

Licenses/Certifications:

MD - Physician - State Licensure Maryland Physician License without restrictions

ABPN - American Board of Psychiatry and Neurology Upon Hire Required.

Knowledge, Skills, and Abilities (KSAs):

Knowledge of managed care concepts and behavioral health care management activities.

Skilled in coordinating and collaborating with physicians.

Knowledge of patient rights and laws relative to those rights, such as HIPAA.

Demonstrated application and knowledge of best behavioral health clinical practices.

Knowledge of principles, practices, evidence-based guidelines and standardized processes and procedures for evaluating medical support operations business practices.

DepartmentDepartment: Medical DirectorsEqual Employment OpportunityCareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.Hire Range DisclaimerActual salary will be based on relevant job experience and work history.Where To ApplyPlease visit our website to apply: www.carefirst.com/careersFederal Disc/Physical DemandNote: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.PHYSICAL DEMANDS:The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.Sponsorship in USMust be eligible to work in the U.S. without Sponsorship.#LI-KL1REQNUMBER: 18232