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Health physicist • rio rancho nm
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JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets / regions. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Provides behavioral health oversight and clinical leadership for health plan and / or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs.
- Facilitates behavioral health-related regional medical necessity reviews and cross coverage.
- Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses.
- Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts.
- Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment.
- Provides second level behavioral health clinical reviews, peer reviews and appeals.
- Supports behavioral health committees for quality compliance.
- Implements behavioral health specific clinical practice guidelines and medical necessity review criteria.
- Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS).
- Assists with the recruitment and orientation of new psychiatric medical directors.
- Ensures all behavioral health programs and policies are in line with industry standards and best practices.
- Assists with new program implementation and supports for health plan in-source behavioral health services.
Required Qualifications
Preferred Qualifications
#PJHS
#LI-AC1
#HTF
To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V
Pay Range : $161,914.25 - $315,733 / ANNUAL