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Medical Director Behavioral Health
Seattle or Tacoma, WA
$200,000.00 - $280,000.00
Medical Doctor; Doctor of Osteopathy;
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Medical Director – Behavioral Health – Seattle Area
New role in the organization will collaborate with the VP of Medical Affairs to direct and coordinate the physician component of the utilization management functions for the local health plan, with emphasis on the behavioral component of the integrated care programs.
· Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants
· Performs case reviews and appeals for all health plans.
· Assists VP of Medical Affairs in planning, establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
· Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
· Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
· Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
· Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment
Medical Doctor or Doctor of Osteopathy, board certified in Psychiatry.
Must be an actively practicing physician.
Must have previous experience within a managed care organization.
Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred.
License/Certifications: Board certification by the American Board of Psychiatry.
Current WA medical license without restrictions required.
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