Sr. Medical Director – Behavioral Health

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CENCAL HEALTH

Company Description

Looking for a career that makes a difference in people’s lives?  CenCal Health is a locally-run, not-for-profit health plan that serves nearly 180,000 people, with offices in both Santa Barbara and San Luis Obispo Counties.

For 35 years we’ve been improving the health and well-being of our neighbors through partnership and collaboration, and we’re looking for exceptional, mission-driven professionals to help us grow.

We are an employer of choice in Santa Barbara, offering competitive salaries, generous vacation & holidays, comprehensive health/dental/vision benefits including a CalPERS pension plan and 457 deferred income plan, a wellness program, a gym in our headquarters and even parking lot BBQs. Come join our group of nice people doing good work at a great company.

For more information on who we are and what we do, please visit our website at www.cencalhealth.org

Job Description

  Serve as a member of the senior leadership team and participate in strategic planning efforts.

·         Develop, implement, manage and improve the delivery of integrated care management and care coordination services as it relates to mental and behavioral health.

·         Play a key role in developing, implementing, and improving integrated care management services for high risk/high cost mental and behavioral health members and the delivery of integrated medical care

·        If the mental/behavior health program is brought in-house, conducts clinical reviews and makes UM decisions for prior, concurrent and retro authorizations, and appeals; approves/denies or offers medical alternatives according to CenCal Health medical review criteria, conducts peer to peer consultations with providers, support and participate in State Fair Hearing cases, develops UM policies and procedures in coordination with Health Services staff

·         Ensure the appropriate and timely use of UM criteria and guidelines and medical policy in the administration of treatment to CenCal Health members.  Develop mental and behavioral health medical policies and clinical programs to support members and providers, consistent with CenCal’s mission to the community.

·         Support care coordination staff with specialized knowledge of chronic co-morbid condition management, care integration, transitions, referral management, and all other aspects of care management and care coordination as it rtelates to mental and behavioral health ensuring that activities meet current Medi-Cal, Medicare and generally accepted standards.

·         Use data effectively to drive performance improvement.  Support data driven strategies/initiatives.  Take an active role in developing data collection and analytics capabilities.

·         Assist the mental and behavioral health Case Managers and Utilization Review Managers in identifying and implementing services appropriate to an individual member’s plan of care.

·         Identify member and community populations needing improvements in health care access, preventive care, care coordination and develops methods for population health monitoring

·         Perform clinical quality of care reviews and investigations.

·         Serve as a clinical subject matter expert in mental and behavioral health for other CenCal Health departments.

·        Establish and maintains working relationships with providers, provider organizations and other stakeholders that support contracting, provider relations, marketing and other organizational goals and objectives

·         Represent CenCal Health in community initiatives and collaborative efforts as assigned.

·         Stay current with State and Federal mandates and benefits to ensure CenCal Health Services Department is in full compliance.  This includes oversight of delegated entities/providers

·         Perform other duties as assigned

·         Comply with all CenCal Health safety requirements.

·         Adhere to all CenCal Health employee policies and procedures, and meet required performance standards

·         Ensure appropriate confidentiality of data and findings

·         Accomplish staff results by communicating  job expectations; planning, monitoring, and appraising  job results; coaching, counseling, and implementing  corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.  Complete performance evaluations in a timely manner

·         Develop and enhance professional mental and behavioral health medical community relationships including communications with similar Health Plan organizations

·         Strategic Orientation- Actively participates with other executives in the development and execution of strategic and operating plans. Responsible for analysis, detailed plans and budgets, and defining measures of success for the Mental and behavioral health programs of Health Services, as well as participation in other health plan and system activities.

·         Relationship Management – Responsible for developing and maintaining strong relationships and credibility with key constituencies, including all elements of CenCal’s delivery system, key clients, network providers, medical and pharmacy vendors, etc.

·         Affiliate Performance – Strong collaboration with executives responsible for each affiliate’s strategic and operating initiatives in the areas of mental and behavioral health medical-related operations, including quality of care and effective cost management.

·         Leadership Development – Responsible for leadership development of CenCal’s physician medical management team and related clinical management/staff at CenCal Health, including establishing a leadership climate that contributes to a highly engaged and diverse workforce committed to CenCal’s Vision, Mission and Values.

·         Community and Industry Involvement – Maintain a visible leadership role in appropriate civic, professional and industry related organizations.

·         Policies and Procedures – Development and maintenance of all departmental operational and service policies and procedures aligned with company objectives.

·         Innovation and Special Projects – Serves as medical lead in design and development of innovative programs and special projects that reduce administrative burdens and/or improve the quality of care, provider satisfaction or member satisfaction.

Qualifications

Board Certification in Psychiatry recognized by the American Board of Medical Specialties

Minimum five years of medical administrative experience.

Minimum five years of post-residency/training experience.

Managed Care experience such as Utilization Management experience for an IPA, medical group or HMO highly desirable

Knowledge and experience with administrative practices and procedures (including but not limited to: quality assessment and improvement, utilization review, peer review, credentialing and risk management, rules regulations, policies and standards related to managed care, principles of effective supervision and organization, methods, techniques, practices, principles and literature in the broad field of medical sciences)

Experience with vendor oversight through delegation accountability

Managed health care experience to include clinical practice, quality and regulatory aspects.

Additional Information

If you are interested in joining the team at CenCal Health, please apply at:

https://recruiting2.ultipro.com/SAN1015SBHA/JobBoard/be64234c-c47d-4274-b3c6-8cac051e31e3/?q=&o=postedDateDesc


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