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.
Provides Psychiatric leadership for utilization management and case management programs for mental health and chemical dependency services. Indirectly supervises Health Plan Psychiatric Medical Directors in implementing integrated Behavioral Health care management programs. Works closely with the MHI VP of Behavioral Health and National Medical Directors to develop standardized utilization management policies and procedures to be implemented enterprise-wide that will improve quality outcomes and decrease costs.
• Develops scorecard benchmarks for Behavioral Health (BH) clinical staff productivity.
• Standardizes UM practices and quality and financial goals across all LOBs.
• Responds to BH-related RFP sections and review BH portions of state contracts.
• Works with trainers to develop and provide enterprise-wide teaching on psychiatric diagnoses and treatment.
• Writes, refines, and approves BH Policies and Procedures for utilization and case management.
• Provides second level BH clinical reviews, BH peer reviews and appeals.
• Facilitates BH committees for quality compliance.
• Works with VP Pharmacy to establish standard Psychiatric formulary.
• Implements clinical practice guidelines and medical necessity review criteria.
• Tracks all clinical programs for BH quality compliance with NCQA and CMS.
• Participates in the recruitment, placement and orientation of new HP 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.
• Assist with reviewing and evaluating BH vendors.
Doctorate Degree in Medicine (MD or DO) with Board Certification in Psychiatry
• 2 years previous experience as a Medical Director.
• 3 years experience in Utilization/Quality Program Management.
• 5+ years clinical practice.
• 5+ years HMO/Managed Care experience.
• Current clinical knowledge.
• 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.
• 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.
Preferred License, Certification, Association
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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