Medical Director, Behavioral Health (Finance)

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

*This role is part-time and will require around 25 hours per week.

Job Summary

Provides clinical oversight to TriWest-directed BH activities throughout the West Region. Functions as the senior Behavioral Health clinical consultant for TriWest medical management reporting to the TriWest Behavioral Health Chief Medical Officer (CMO). Consults directly with TriWest staff on clinical Behavioral Health issues.

Education & Experience

Required:

• Medical Doctor Degree
• Current unrestricted license to practice medicine in a state or territory of the United States
• Board Certified in Psychiatry
• 5+ years' clinical practice experience
• 5+ years' medical management experience in a Managed Care environment
• Experience with utilization Management, Quality Management, Case Management, and Disease Management

Preferred:

• Advanced degree or certificate in medical management
• TRICARE or Government experience

Key Responsibilities

• Consults with practitioners in the field.
• Functions as the Behavioral Health clinical authority at TriWest.
• Collaborates with CMOs, other medical directors, medical management leadership, and staff, on the development and implementation of integrated behavioral healthcare management practices.
• Acts as lead consultant to Sr. VP Medical Management & Chief Medical Officers, VP, and other senior staff on BH-related matters.
• Supports medical management staff in the conduct of clinical case reviews and focused studies and reviews.
• Conducts medical necessity review and is available for peer to peer discussions.
• Assists in physician-to-physician communications with BH clinicians related to practice pattern enhancement.
• Consults, advises, and provides clinical supervision to TriWest clinical staff on Behavioral Health- related responsibilities.
• Provides direct support to Team Coordinators, Behavioral Health and other Medical Directors.

• Works with other Medical Directors on committees and projects to support TriWest's Medical Management program.
• Works with BH clinical advisors and local BH advisory committees in the Service Areas.
• Advises Directors of Utilization Management (UM), Quality Management (QM), Case Management (CM), and Disease Management (DM) and staff on Behavioral Health matters.
• Provides clinical consultation to staff and oversight for decisions effecting beneficiaries.
• Chairs committees as required.
• Reviews Behavioral Health operations with management team to identify and implement quality and process improvements.
• Consults with TriWest staff on clinical decisions and reviews.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Knowledge of health care cost containment and continuous quality improvement; familiar with Child and Adolescent Psychiatric services, levels of care, and neuropsychiatric testing; knowledge of Managed Care practices, URAC standards and process, HIPPA regulations and requirements and Managed Behavioral Health care practices; ability to work in a matrix environment.

Working Conditions

Working Conditions:

• Availability to work non-regular hours as required
• Works in a standard office environment, with minimal travel
• Extensive computer work with prolonged sitting
• Department of Defense security clearance required

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Generous paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

*Annual full time base salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $257,000-$329,000 depending on experience*

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.