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Medical Director, Behavioral Health

  • Location: Chapel Hill, 27517
  • Job Type:Contract

Posted about 1 month ago

Our Healthcare Insurance client is seeking a Associate Medical Director to join their team for a contract-to-hire role!

Our client has more than 5,000 employees and is the number 1 health insurer in the state of North Carolina serving more than 3.89 million customers.  Health care is changing, and our client is leading the way by provide innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.

Position: Medical Director, Behavioral Health
Location: Durham, NC or can work remotely from one of the following states:  Alabama, Arizona, Colorado, Florida, Georgia Idaho, Pennsylvania, Maryland, Michigan, South Carolina, Tennessee, Virginia.
Term: 6 months, contract to hire

Day-to-Day Responsibilities

  • Serves as an interface between the company and physicians, providers, employer and community groups, and members as needed.
  • Utilizes clinical knowledge and experience to support value-based strategies, clinical operations and our pursuit of high quality and efficient care for members
  • Clinical leadership for behavioral health strategic initiatives and care management
  • Project planning and management
  • Operations
  • Medical reimbursement and policy
  • Care management (utilization management, case management, PA, appeals)
  • Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.
  • Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements.
  • Healthcare programs (alternative payment models, supporting providers to deliver integrated care)
  • Behavioral health network support (Communication, credentialing, quality reporting)
  • Partnership
  • Ongoing provider engagement functions
  • Data gathering, management and analysis
  • Evaluate clinical and other data to identify opportunities for improvement in health outcomes and financial performance
  • Discuss data and performance with providers, employers, accreditors and regulators as needed.
  • Communications
  • Represent client through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and internal initiatives.

Is this a good fit? (Requirements):

  • MD or DO from an accredited medical school
  • Completion of residency training program in ABMS/AOA recognized clinical specialty.
  • 5 years of clinical experience following the completion of a residency program is required.
  • Some relevant experience outside of clinical practice is also required (i.e. private or government health plan, consulting house, academic roles, employee health programs, regulatory agency at state or federal level, etc.)
  • For some roles, a current North Carolina medical license and/or Board certification in ABMS/AOA recognized specialty is required.
  • State of NC Licensure
****To be eligible to contract at this client you must be able to pass a drug test and criminal background check. This client requires all employees, temporary labor, consultants, and contractors to be fully vaccinated against COVID-19 by 12/08/21, subject to approved medical or religious exemptions.

Candidates will be responsible for following the client's COVID-19 protocols. Please refer to your MATRIX representative for specifics.

About Us

At MATRIX, we expertly match talented professionals with job opportunities to elevate careers. Since 1983, we have placed thousands of professionals at innovative clients across every industry ranging from small startups to Fortune 50 companies. It’s why we’re consistently in the top 25 of all U.S. IT staffing firms and why our consultants rate us well above the industry average, earning us ClearlyRated's Best of Staffing awards year after year. People come to us for a job, and stay with us because of our top-notch consultant care.

MATRIX is and Equal Employment Opportunity employer and provides reasonable accommodations for qualified individuals.  Supporting medical or religious documentation will be required where applicable. If you are a qualified individual with a disability, you may request a reasonable accommodation under the American Disability Act (ADA) by emailing MATRIX_HR@MatrixRes.com. To ensure a quick response to your request, please use the words “Accommodation request” as the subject line of your email.