Medical Director, Behavioral Health

Date: Jul 19, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5438 

 

Position Summary/Position

 

Under the direction of the Chief Medical Officer and Senior Medical Director, the Medical Director of Behavioral Health is responsible for clinical oversight and management of the IEHP behavioral health activities and case management, and participates in quality management, utilization management (UM), and grievance and credentialing functions for the Behavioral Health Program. In partnership with Health Services Senior Leadership, the Medical Director oversees the inpatient/concurrent review process, care integration efforts, and all levels of behavioral health care provided to IEHP Members. The Medical Director coordinates care with the County Mental Health Plans that are responsible for the care of the population with a Serious Mental Illness (SMI), the County Alcohol and Drug Program, as well as all IEHP community and provider partners.

Major Functions (Duties and Responsibilities)

 

1. Provides overall clinical leadership and develops and implements clinical policies for the IEHP Behavioral Health Program.  This includes delivery of mental health services, substance use services, medication management, and coordination of behavioral health services and primary care.
2. Provides direction of current clinical practices for behavioral health services.  Ensures that qualified medical/clinical personnel render clinical decisions regarding behavioral health, unhindered by fiscal or administrative management, and consistent with regulatory requirements and UM guidelines.
3. Leads Behavioral Health quality improvement efforts while helping to manage health plan medical costs, assuring an appropriate and efficient health care delivery system for IEHP members and supporting IEHP strategic goals.
4. Monitors performance of behavioral health providers and leads performance improvement efforts in the network to improve the quality of services delivered to IEHP members in collaboration with the Deputy Chief Medical Officer, Care Management and Utilization Management.
5. Leads efforts to further integrate substance use treatment into the care delivery system, including implementing integrated care models that increase access to Medication Assisted Treatment (MAT) along with substance use counseling and other evidence-based addiction interventions.
6. Develops targeted education, training, and clinical guidance to contracted primary care physicians (PCPs) treating behavior health-related concerns not requiring referral to behavior health specialists.
7. Provides medical direction and guidance to the Behavioral Health Department in the arena of inpatient, outpatient pre-service authorizations and utilization management, including the coordination of care with external agencies, consultation on complex cases, and participation in Interdisciplinary Care Teams/case conferences.
8. Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost, and outcomes.
9. Reviews cases and ensures appropriate adjudication of prior authorization.  Directly reviews all medical necessity denials and modifications of a prior authorization requests.
10. Ensures the creation, modification, and appropriate and timely use of UM criteria for both inpatient and outpatient authorizations.
11. Identifies and develops opportunities for innovation to increase effectiveness and quality.
12. Ensures that assigned patients have access to behavioral health services coordinated with primary and specialty care throughout IEHP’s geographic coverage area.  Partners with the Contracting Department to ensure a full and appropriate primary and specialty behavioral health care provider network for Members.
13. Consults on written protocol for IEHP behavioral health providers to ensure adherence to standards and quality of care.  Coordinates professional interactions among practitioners and lends assistance toward correcting any deviation from standards. Develops relationships with directly contracted behavioral health providers.
14. Reviews State mandated benefits to ensure the IEHP Behavioral Health Program is in full compliance through its providers.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Five (5) years of post-residency or Licensure experience in a recognized psychiatric specialty.

Preferred Experience

 

At least three (3) years of psychiatric administrative experience preferred. Preferred experience is in a variety of clinical settings including inpatient psychiatric, outpatient practice, and community-based care settings. Utilization Management experience with an IPA, medical group or HMO highly desirable. Experience with Medi-Cal managed care is a plus.

Education Qualifications

 

Doctorate of Medicine from an accredited institution required.

Preferred Education

Professional Certification

 

Certification by an American Specialty Board in Psychiatry. 

Professional Licenses

 

Possession of an active, unrestricted, and unencumbered Physician’s and Surgeon’s Certificate issued by the State of California Medical Board required.

(A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California physician and surgeon’s certificate is filed in the state of California prior to date of appointment.)

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Administrative practices and procedures including but not limited to quality assessment and improvement, utilization review, peer review, Credentialing and risk management; rules regulations, policies, and standards related to managed care; principles of effective supervision and organization; methods, techniques, practices, principles, and literature in the broad field of medical sciences; and overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties.

Skills Requirement

 

Microcomputer applications such as Microsoft Word, Excel, and Access helpful.

Abilities Requirement

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Indoors - FREQUENTLY
Lighting - CONSTANTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

 

Starting Salary: $227,052.80  - $312,187.20  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles