Medical Director, Behavioral Health Strategy and Execution

PURPOSE :

The CareFirst office of the Chief Medical Officer seeks a results oriented Medical Director to lead our behavioral health strategy and execution.

Using strong financial acumen and business experience, the ideal candidate will drive system transformation including Behavioral Health integration, new models of care, value-based contracting, and more.

Key competencies include strong critical thinking and analytical skills, knowledge of industry trends, thought leadership, strategy orientation and a passion for making a difference in the wellbeing of the members and communities we serve.

The Medical Director in partnership with internal Behavioral Health clinical leaders, drives the development and implementation of innovative and integrated behavior health continuum of care for all CareFirst lines of business.

Supports all activities of utilization review, care management and quality to determine the medical effectiveness related to behavioral health and substance use.

ESSENTIAL FUNCTIONS :

Leads the behavioral health strategy and execution reflective of industry trends and business needs. Provides clinical, programmatic, and consultative services to ensure that various health plans are providing affordable and accessible care options at the right time and right level of care to meet member and account needs.

Works collaboratively with fellow Behavioral Health Medical Director to ensures that the provision of behavioral health care service to the membership is compliant with the medical policies and standards.

Participates in medical necessity reviews, including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals.

Proposes policies and standards for review and resolution to the committee and communicate these policies and standards to physicians participating in the network.

Supports 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 capacity analysis and planning for improving access to care and implementing population specific value based behavioral care solutions through a continuum of provider partnerships.

Represents the Company within provider community, professional organizations, legislative work groups and governmental agencies.

Regularly engages in public speaking with the external medical community, including direct engagement with members, accounts, business leaders, industry organizations and more.

Supports after hours function.

QUALIFICATIONS :

Education Level : Medical Degree in accredited medical school, completion of an American residency program.

Licenses / Certifications Upon Hire Required :

• MD - Physician - State Licensure Maryland Physician License without restrictions.
• ABPN - American Board of Psychiatry and Neurology.

Experience :

• Minimum of 5 years clinical practice experience in the field of psychiatry.
• 2 years managed care experience with Accreditation experience.

Preferred Qualifications :

• MBA, Master’s degree in Public Health, Population Health or related discipline (in addition to Medical Degree).
• Strong background in statistics, economics, quantitative analysis.

Knowledge, Skills and Abilities (KSAs) :

• Strategy orientation
• Strong financial acumen and cost analysis experience.
• Knowledge of industry trends.
• Demonstrated leadership of multidisciplinary Behavioral Health Services across the continuum-of-care.
• Experience in value-based or alternative payment models.
• Comfort level and experience with public speaking and presenting to multi-faceted constituent groups.
• 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.

Department

Department :

Equal Employment Opportunity

CareFirst 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.