grandrapids | Medical Director, Behavioral Health in Grand Rapids, MI

Medical Director, Behavioral Health

  • Spctrum Health
  • $94,340.00 - 205,690.00 / Year *
  • 1601 Mapleview St SE
  • Grand Rapids, MI 49508
  • Full-Time
save job button



Medical Director, Behavioral Health
51569
2019-03-07T00:00:00-05:00
0001-01-01T00:00:00
Grand Rapids
MI
Priority Health
This position is critical to Priority Health's mission of improving the health and lives of the people we serve in collaboration with the health plan's provider partners and major delivery systems.
Provide comprehensive behavioral health care management and clinical oversight for Priority Health's Behavioral Health clinical and utilization management programs. Develop and drive innovative behavioral health strategies that focus on improving health and managing costs for all lines of business.
Essential Functions:
* Provide clinical leadership and guidance for behavioral health case management and utilization management programs, including authorizations, denials and appeals.
* This position will have a strong strategic focus toward utilization management in an effort to facilitate the right care, at the right place, at the right time for the right cost.
* Conduct peer to peer case reviews for medical necessity determination as necessary.
* Recommend, develop, implement and interpret behavioral health medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments.
* Develop and enhance relationships and clinical partnerships within the behavioral health provider community.
* Collaborate as necessary to assure compliance with all regulatory programs impacting behavioral health, including National Committee for Quality Assurance (NCQA), CMS, State Medicaid, MHPAEA, State Mental Health Code, 42 CFR Part 2 and Mental Health Parity requirements.
* Provide clinical expertise in the evaluation of behavioral health quality improvement, reimbursement methodology, fee review, claim payment, and fraud and abuse.
* Be the thought leader on innovative behavioral health strategies to drive better care, improve health, and lower cost.
* Engage in demonstrating the value proposition for behavioral health clinical program through quantitative analytics, ROI an evidence-based data.
Basic Qualifications:
Education - Medical Degree (MD or DO) from a medical school approved by the Council on Medical Education of the American Medical Association or an osteopathic school approved by the Council for the American Association of Colleges of Osteopathic Medicine
Experience - 3 years of experience typically gained through skills/knowledge/abilities in a clinical setting, along with 3 years of experience in managed care
Preferred Qualifications:
Experience - Proven experience and evidence of success in effective physician communication and education skills; evaluation of evidence-based standards of care including the ability to critically analyze data; clinical program development and assessment; physician and clinical practice partnership development and application of utilization management skills and strategies
Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected category.

Education - Medical Degree (MD or DO) from a medical school approved by the Council on Medical Education of the American Medical Association or an osteopathic school approved by the Council for the American Association of Colleges of Osteopathic Medicine Experience - 3 years of experience typically gained through skills/knowledge/abilities in a clinical setting, along with 3 years of experience in managed care Preferred Qualifications: Experience - Proven experience and evidence of success in effective physician communication and education skills; evaluation of evidence-based standards of care including the ability to critically analyze data; clinical program development and assessment; physician and clinical practice partnership development and application of utilization management skills and strategies


Associated topics: community, hospital, lead generation, mba, media, principle gift, product market, regulatory, relation, university relationship


* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.