Behavioral Health Medical Director - Psychiatrist - Colorado Medicaid

Behavioral Health Medical Director - Psychiatrist

Location policy: role enables virtual work with required in-person training sessions. Alternate locations may be considered (preferably West Coast). Hybrid/virtual work considerations apply per policy.

The Behavioral Health Medical Director is responsible for the administration of behavioral health medical services, ensuring appropriate and cost-effective medical care. May develop and implement programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost-of-care opportunities. Works independently with oversight from immediate manager. May supervise an entire clinical program and/or independently perform clinical reviews.

Typical program management responsibilities include clinical policy development, program development/implementation, and oversight of clinical/non-clinical activities.

How You Make An Impact

• Supports clinicians to ensure timely and consistent responses to members and providers.
• Provides guidance for clinical operational aspects of a program.
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• Serves as a resource and consultant to other areas of the company.
• May be required to represent the company to external entities and/or serve on internal and/or external committees.
• May chair company committees.
• Interprets medical policies and clinical guidelines.
• May develop and propose new medical policies based on changes in healthcare.
• Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality, cost, and outcomes.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.

Minimum Requirements

• Requires MD or DO and Board certification approved by ABMS or AOA, as applicable.
• Must possess an active unrestricted medical license to practice medicine in the state of Nevada.
• Must be located in a U.S. state or territory when conducting utilization review or appeals; cannot be located on a U.S. military base, vessel, or embassy, unless allowed by law.
• Minimum of 10 years of clinical experience; or any combination of education and experience with equivalent background.
• For Health Solutions and Carelon organizations (including behavioral health), minimum of 5 years of healthcare experience.
• Additional experience may be required by State contracts or regulations if applicable.

Preferred Skills, Capabilities And Experiences

• Addiction medicine/psychiatry certification strongly preferred.
• Experience working with addiction population strongly preferred.
• 1–2 years utilization management experience strongly preferred.
• Managed care experience strongly preferred.
• Strong oral, written, and interpersonal communication, problem-solving, facilitation, and analytical skills.

Salary range for this position in Colorado: $262,152 to $393,228. Locations:
Colorado.

Elevance Health offers a comprehensive benefits package and emphasizes equal pay opportunities and non-discrimination. Hybrid workforce expectations and COVID-19/Influenza vaccination requirements may apply per policy. Equal Employment Opportunity statement and accommodations information are provided as part of our job process.