Medical Director – Behavioral Health

Job not on LinkedIn

🔥 57 minutes ago

🌲 Oregon – Remote

🌲 Oregon – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Implement effective utilization review, care management, and clinical practice strategy development and improvement initiatives • Develop, recommend, implement, execute, and manage behavioral health and integration programs • Develop and manage clinical and wellness programs addressing member needs • Provide psychiatric consultation to Care Management activities • Perform benefit determinations, appeals, and quality of care investigations in behavioral health • Develop and oversee clinical strategy and interventions for clinical systems • Develop a high-performing system of care with measurable outcomes • Collaborate with multidisciplinary teams and community partners • Oversee clinical strategy for substance use disorders • Participate in value-based payment model development for behavioral health networks • Implement and oversee utilization, case, disease, and quality management programs • Educate participating physicians on quality and utilization management • Represent the health plan in professional and community activities • Serve as medical spokesperson for service area expansions, contract negotiations, and provider expansion • Provide advanced technical support to clinical and non-clinical staff • Propose and implement process improvements • Maintain workload deadlines, schedule, cooperation, teamwork, and cross-training • Report through a matrix relationship to the Senior Medical Director

🎯 Requirements

• Doctor of medicine or osteopathy in the specialty area of pediatric/adolescent psychiatry • Possession of or ability to obtain an unrestricted license to practice in Oregon • Minimum 5 years of relevant and progressive experience in a managed care organization or practice setting, preferably with Medicaid, including or following strong clinical practice activity • Minimum 4 years’ experience in a supervisory position (preferred) • Board certification (preferred) • Knowledge of medical policy related to quality, case and disease management and credentialing activities • Thorough knowledge of the adult mental health system of care, including state hospital, criminal justice, and involuntary commitment processes • Working knowledge of children’s system of care and Wraparound program • Clinical knowledge of management of diverse medical problems • Knowledge of regulatory and contractual requirements for Medicaid, Medicare, and commercial insurance • Understanding of managed care operations • Demonstrated use of quality management techniques in a large, organized managed care setting • Familiarity with guideline development, outcomes management, population health improvement, disease management, cost effectiveness, and cost analysis studies • Ability to work effectively with diverse individuals and groups • Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

🏖️ Benefits

• Bonus opportunity • Medical, dental, vision, life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • PTO • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions for non-benefits eligible employees • Flexible work arrangement: Work from home