Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE

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Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE Work from home within Oregon, Washington, Idaho or Utah This is a part-time non-benefited position with a maximum of 12 hours per week.

Who We Are Looking For Every day, Cambia’s dedicated team of physicians is living our mission to make health care easier and lives better.

As a member of the Utilization Management (UM) team, our Associate Medical Director BH and UM Medical Directors provide leadership, and clinical oversight for behavioral health operations across all lines of business within the health plan, with a primary focus on behavioral health utilization management.

What You Bring to Cambia Qualifications Licensed Physician with an MD or DO degree Active, unrestricted license to practice medicine in one or more of our 4 states Board Certification in general psychiatry or child psychiatry required with preference for being board certified in both Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review At least 3 years clinical experience Two years health plan medical utilization management and/or case management experience Equivalent combination of education and experience Must be located in one of our four states Skills and Attributes In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes Passion for population health, healthcare transformation and improving the experience of people with mental health issues Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes Proven ability to develop and maintain positive working relationships with community and provider partners Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods and evolving accountable care and payment models is preferred Experience conducting medical case reviews for utilization and/or case management is strongly preferred Detail-oriented with orientation to the application of data and metrics in managing health, quality and program effectiveness Leadership experience with demonstrated ability to effectively build relationships, work with others and lead people and project teams Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired What You Will Do at Cambia Complete Behavioral Health utilization management reviews, including PA, appeals and post-service Develop and implement Behavioral Health Policies and Programs: Assist in developing high-quality, market-competitive behavioral health medical policies and programs, and provide leadership in developing short and long-range plans, goals, and objectives for integrated utilization management Operational Leadership and Oversight: Oversee the development of effective operational policies, procedures, and standards for an integrated behavioral health program, monitor utilization and results, and implement process or system changes as needed Subject Matter Expert and Clinical Leadership: Serve as a subject matter expert on behavioral health, provide medical advice, oversight, and leadership for staff, and ensure members receive safe, effective, and cost-efficient services Collaboration and Communication: Collaborate with the Executive Medical Director of Behavioral Health, lead/participate in teams for medical policy reviews and development, and discuss review determinations with providers to promote understanding of utilization management and quality improvement policies Industry Trends and Opportunities: Stay abreast of industry, medical, and technology trends, identify and communicate new opportunities to enhance outcomes and the organization’s reputation, and collaborate to implement actions to reduce medical cost trend Other roles as assigned #LI-Remote Pay ranges vary based on the candidate’s work location.

Whether we’re helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through. Why Join the Cambia Team?

At Cambia, you can: Work alongside diverse teams building cutting-edge solutions to transform health care Earn a competitive salary and enjoy generous benefits while doing work that changes lives Grow your career with a company committed to helping you succeed Give back to your community by participating in Cambia-supported outreach programs Connect with colleagues who share similar interests and backgrounds through our employee resource groups We believe a career at Cambia is more than just a paycheck – and your compensation should be too.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same.

Just a few highlights include: Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits Annual employer contribution to a health savings account Generous paid time off varying by role and tenure in addition to 10 company-paid holidays Market-leading retirement plan with a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period) Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave) Award-winning wellness programs that reward you for participation Employee Assistance Fund for those in need Commute and parking benefits We are happy to offer work from home options for most of our roles.

Join our Cause to create a person-focused and economically sustainable health care system. Partners with leaders and staff across the organization to ensure policies, programs and strategies related to our members.

Conducts case reviews requiring physician involvement and/or provides clinical expertise to others related to behavioral health case management, prior authorizations and appeals. Provides peer-to-peer consultations with providers – all in service of creating a person-focused health care experience.

Are you a motivated and experienced medical professional looking for a new challenge? Do you have a passion for patient care and want to make a big difference in healthcare? Then this role may be the perfect fit.

The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Associate Medical Director Oregon, Washington, Utah, and Idaho: The expected hiring range is $217,600 - $294,400, the full salary range is $204,000 - $333,000 and the bonus target is 25%.

North Dakota: The expected hiring range is $217,171.97 - $293,820.91 and the full salary range is $192,827.15 - $318,165.72. Medical Director Oregon, Washington, Utah, and Idaho: The expected hiring range is $238,850 - $323,150, the full salary range is $224,000 - $366,000 and the bonus target is 30%.

North Dakota: The expected hiring range is $252,506.91 - $341,626.99, the full salary range is $224,201.29 - $369,932.61 and the bonus target is 20%. About Cambia Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history.

Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. #J-18808-Ljbffr