Senior Medical Director, Behavioral Health - New Mexico

Senior Medical Director, Behavioral Health - New Mexico

Location: Remote in New Mexico

Job Description:

• Supports the clinical vision for the health plan(s) for all lines of business (Medicaid, Medicare, and Commercial)
• Implements and manages programs to support this vision
• Ensures delivery of appropriate health care by overseeing service coordination, utilization management, care/case management, population health/disease management, cost of care, health promotion, quality improvement programs, and medical action plans
• Leads parity efforts and maintains parity documentation
• Analyzes utilization, quality, and financial data for high quality and cost-effective care
• Monitors Medical Directors and Physician Advisors for cost-effective and quality care management
• Develops and sustains an interface with providers, health plan partners, members, and state agencies
• Provides clinical leadership to the Medical Management team, including clinical/medical oversight and consultation
• Responsible for utilization review determinations and appeals
• Ensures compliance with case management and disease management programs
• Evaluates effectiveness and cost of care of clinical programs
• Handles external stakeholders, including health plan and state government partners
• Provides medical leadership, oversight, and consultation for Quality Improvement Programs
• Develops and manages medical director and physician advisor budgets
• Develops and implements the Medical Action Plan (MAP) for health plans
• Implements medical policies/procedures and provides input on modifications
• Participates in RFP response development and writing
• Provides after-hours coverage as required

Requirements:

• Targeted specialties: Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care, or Physical Medicine
• Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or Bachelor of Medicine, Bachelor of Surgery (MBBS) with relevant training and certification
• Post-residency experience of at least 7 years involving substantial direct patient care
• Unrestricted current and valid license or certification to practice medicine in a state or territory of the United States
• Ability to lead and effect appropriate changes
• Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance, and continuous quality improvement (CQI) processes

Professional Development:

• Opportunity to lead and manage clinical and medical management programs
• Involvement in Quality Improvement and clinical excellence initiatives

Salary Range:

• Salary Minimum: $222,380
• Salary Maximum: $422,520

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary, and other benefits and perks that enhance your physical, mental, emotional, and financial wellbeing.