Behavioral Health Medical Director

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

PURPOSE OF THE JOB

The Behavioral Health Medical Administrator (Medical Director) directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities. The position supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations, to advance timely access to high quality care and services, and to ensure that medical policies, procedures, and activities/actions of the division are consistent with the standards of good medical practice in the community and are in compliance with CMS, AHCCCS contract requirements and other regulatory agencies. The position is under the direction of Medicaid Business Segment Chief Medical Officer and Chief Executive Officer.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 3 years of experience in a clinical setting

· 1 year of experience in physician leadership role, including quality review, utilization review, population health and other managed care functions

2. Required Education

· Medical Degree

3. Required Licenses

· Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)

4. Required Certifications

· Board Certification in general psychiatry, or adult and child/adolescent psychiatry, through the American Board of Psychiatry and Neurology

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· Experience with population health and/or medical management

· Knowledge of NCQA accreditation standards for health plans

· Knowledge of and/or experience with Medicaid or CMS dual special needs health plans.

2. Preferred Education

· Physician leadership, medical management, or population health coursework and training

3. Preferred Licenses

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· The candidate is required to reside in Arizona.

· Provides physician leadership and medical oversight in the design, implementation and review of clinical services, best practices, care management, medical management and quality management delivered by Medicaid Business

Segment and its provider network to adults, children, and adolescents.

· Serves as liaison between the Medicaid Business Segment and medical and behavioral health practitioners at stakeholder and provider agencies through consultations, regional meetings, and agency site visits.

· Participates in aggregate and member-level clinical analyses for Medicaid Business Segment quality management, quality of care concerns, peer review, medical management, and utilization review processes.

· Reviews and authorizes requests by providers and treatment coordinators for services or programs requiring prior authorization or approval by the Medicaid Business Segment, and recommends supplemental evaluation or studies,

when warranted.

· Participates in the design and implementation of best practices, clinical standards, protocols, and treatment guidelines, as they pertain to Medicaid Business Segment’s responsibilities for care provided including adults and

children. Participates in credentialing, re-credentialing and competency processes for Medicaid Business Segment providers of services to adults, children, and adolescents.

· Assists Medicaid Business Segment care managers with care management of high risk/high-cost adults, children and adolescents, members with substance use disorders and members with mental illness by training care managers on

best practices, overseeing individualized care plans, and recommending additional services as necessary.

· Participates as a member or chair of internal and external committees including, but not limited to, the Quality Management Committee, Pharmacy and Therapeutics Committee, Peer Review Committee, Credentials Committee,

and Medical Management and Population Health Committees.

· Participates as a subject matter expert regarding grievance and appeals cases, provider and member complaints and grievances, especially regarding care provided to adults, children, and adolescents.

· Partners with other Medicaid Business Segment plans and programs in the development, oversight and monitoring of shared services.

· Participates in network development activities to ensure a full integrated behavioral health continuum of care for adult, child and adolescent members.

· Review, advise on, and implement medical policies and other medical decision-making policies or procedures.

· Represent BCBSAZ at professional organizations, act as liaison with individual health care professionals, and support collaborative relationships with physicians and hospitals.

· Conduct, as appropriate, appeals and peer review cases in accordance with required qualifications.

· Provide written information to members and providers through letters and articles in member and provider newsletters and other publications.

· Work to ensure productive relationships with all customers, employers, members, and providers to ensure members receive the appropriate health care in the most appropriate setting with the best value in health care.

· Provide leadership to staff and other professionals through clinical excellence, professional behavior and innovative thinking.

· Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.

· Identify opportunities to achieve administrative efficiencies while maintaining high quality service.

· Maintain and promote effective working relationships to ensure teamwork in achieving corporate goals.

· Contribute to departmental and cross-functional teamwork to achieve BCBSAZ goals and ensure future success.

· Some travel may be required.

· Perform all other duties as assigned

· The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Requires knowledge and skills in state (Arizona) and federal behavioral health regulations, requirements for publicly funded services, delivery, operations, and licensure.

· Knowledge of managed care concepts and practices; and emerging and best practices for adult & children’s integrated care programs.

· Ability to use electronic word processing, email, and electronic database resources.

2. Required Professional Competencies

· Excellent customer service and oral/written communication skills

· Ability to multi-task projects and issues on fixed timelines.

· Ability to clearly and effectively communicate, negotiate and advocate both verbally and in writing.

· Ability to maintain confidentiality, privacy, and security of protected information.

· Work effectively and efficiently both independently and as part of a team.

3. Required Leadership Experience and Competencies

· N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills

· Familiarity with NCQA accreditation standards

· Previous experience with AHCCCS and/or state Medicaid or D-SNP programs

2. Preferred Professional Competencies

· N/A

3. Preferred Leadership Experience and Competencies

· N/A

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.