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Role Description

The Behavioral Health Medical Administrator (Medical Director) directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities.

• Supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations.
• Advances timely access to high quality care and services.
• Ensures that medical policies, procedures, and activities/actions of the division are consistent with the standards of good medical practice in the community.
• Reports to the Medicaid Business Segment Chief Medical Officer and Chief Executive Officer.

Qualifications

• 3 years of experience in a clinical setting
• 1 year of experience in a physician leadership role, including quality review, utilization review, population health, and other managed care functions
• Medical Degree
• Active, current, and unrestricted license to practice medicine in the State of Arizona
• Board Certification in general psychiatry, or adult and child/adolescent psychiatry, through the American Board of Psychiatry and Neurology

Requirements

• The candidate is required to reside in Arizona.
• Participates in aggregate and member-level clinical analyses for Medicaid Business Segment quality management, quality of care concerns, peer review, medical management, and utilization review processes.
• Reviews and authorizes requests by providers and treatment coordinators for services or programs requiring prior authorization or approval by the Medicaid Business Segment.
• Participates in the design and implementation of best practices, clinical standards, protocols, and treatment guidelines.
• Assists Medicaid Business Segment care managers with care management of high risk/high-cost adults, children, and adolescents.
• Participates as a member or chair of internal and external committees.
• Partners with other Medicaid Business Segment plans and programs in the development, oversight, and monitoring of shared services.
• Review, advise on, and implement medical policies and other medical decision-making policies or procedures.
• Conduct, as appropriate, appeals and peer review cases in accordance with required qualifications.
• Provide written information to members and providers through letters and articles in member and provider newsletters and other publications.
• Some travel may be required.
• The position has an onsite expectation of 0 days per week and requires a part-time work schedule.

Benefits

• Flexible work arrangements through a hybrid workforce strategy.
• Part-time work schedule defined as working at least 20 hours per week.

Company Description

Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses.

• Awarded a Healthiest Employer
• Provides information and tools to help individuals make better health decisions.