Medical Director, Behavioral Health Services - Washington

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

• Participates in performance and quality based on changes in the healthcare or medical arena.

• Fosters Clinical Practice Guideline implementation and evidence-based medical practice.

• Interprets existing policies and participates in developing new policies.

• Participates as needed in regulatory, professional and community activities to provide input and become knowledgeable regarding regulatory, professional and community standards and issues.

• Ensures that the medical care provided meets the standards for acceptable medical care.

• Develops, Implements and Conducts concurrent and retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care.

• Leads, develops, directs and implements clinical and non-clinical development of Program implementation following State directives and guidelines.

• Develops, Implements and Conducts the evaluation of authorization requests in timely manner and provide support for the CM and RN reviewers and manages the denial process.

• Partner with senior leadership, clinical teams, operations, and external partners to shape the strategic direction for behavioral health care delivery across the health plan.

• Oversee and lead the development, implementation, and ongoing optimization of behavioral health program and strategies across the health plan. Work cross-functionally to design, develop, and provide oversight of innovative behavioral health programs such as mental health parity, community services overutilization, prior authorization, and utilization management reform.

• Serve as the internal subject matter expert on behavioral health, providing strategic consultation and guidance to cross-functional partners such as Utilization Management, Care Management, Network, Quality, etc.

• Interpret and implement clinical guidelines and policies related to behavioral health. Advise on the latest best practices, treatment protocols, and regulatory requirements in behavioral health care.

• Represent the organization for legislative and government affairs initiatives such as mental health parity, community services overutilization, prior authorization, and utilization management reform.

• Analyze data related to behavioral health outcomes and program effectiveness; utilizes insights to inform strategy and program development.

• Monitor and analyze medical trends to assess program effectiveness, identify gaps in services, and inform decision-making processes. Monitor key performance indicators to drive continuous improvement.

• Build strong cross- functional relationships with PHCO, Network & Quality to implement business strategies.

• Translate high-level strategies into actionable plans, ensuring alignment with corporate goals and objectives.

• Stay informed of changes in healthcare policies and adapt programs accordingly. Ensure all behavioral health programs adhere to state and federal regulations, accreditation standards, and best practices.
• Performs other duties as assigned.

• Complies with all policies and standards.

For Coordinated Care - Washington:
Experience: 2+ years experience leading and supporting behavioral health program development and innovation required. 2+ years experience working with behavioral health regulatory agencies required. 2+ years experience supporting large-scale behavioral health strategy required. 2+ years experience partnering with cross-functional teams to produce position statements and operations playbooks preferred.

License/Certification: License/Certification: Doctorate Degree in Medicine. Washington state license as a MD without restrictions, limitations, or sanctions from government programs. Board certification by the American Board of Psychiatry and Neurology. Additional board certification in child and adolescent psychiatry and/or Addiction Medicine highly preferred. required

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act