JOB DESCRIPTION

Job Summary

Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.

Must be able to work Pacific Time Zone

Knowledge/Skills/Abilities

Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs.  

•     Provide regional medical necessity reviews and cross coverage

•     Standardizes UM practices and quality and financial goals across all LOBs

•     Responds to BH-related RFP sections and review BH portions of state contracts

•     Assist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatment

•     Provides second level BH clinical reviews, BH peer reviews and appeals

•     Supports BH committees for quality compliance.

•     Implements clinical practice guidelines and medical necessity review criteria

•     Tracks all clinical programs for BH quality compliance with NCQA and CMS

•     Assists with the recruitment and orientation of new Psychiatric MDs

•     Ensures all BH programs and policies are in line with industry standards and best practices

•     Assists with new program implementation and supports the health plan in-source BH services

•     Additional duties as assigned

 

Job Qualifications

REQUIRED EDUCATION:

• Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry

REQUIRED EXPERIENCE:

• 2 years previous experience as a Medical Director in clinical practice

• 3 years’ experience in Utilization/Quality Program Management

• 2+ years HMO/Managed Care experience

• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.

• Knowledge of applicable state, federal and third-party regulations

Required License, Certification, Association

Active and unrestricted State Medical License, free of sanctions from Medicaid or Medicare. 

Preferred Experience

• Peer Review, medical policy/procedure development, provider contracting experience.   

• Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.

 

 

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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