Medical Director, Substance Use Disorder

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Medical Director for Substance Use Disorder (SUD) will be responsible for leading WellSense initiatives aimed at improving the health outcomes of our members with a focus on SUD and related health and wellness challenges. The Medical Director will provide clinical leadership, strategic direction, and oversight for SUD programs within our health plan, ensuring that our services align with best practices and regulatory requirements. This position is also necessary to meet regulatory obligations in New Hampshire.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

• Clinical Leadership:




• Meet in person with NH SUD providers and PCPs to assist expansion of SUD services as well as educate SUD providers about regulatory requirements (greater than .5 FTE of role).
• Develop and grow in person and in-state partnerships to educate SUD Providers regarding appropriate treatment plans, documentation, and billing practices.
• Responsibility for providing clinical oversight and guidance on SUD issues, such as the use of ASAM or other evidence-based assessments and treatment protocols, the use of MAT, engagements with PRSS, and discharge planning for Members who visit an ED or are hospitalized for an overdose.
• Oversee the development and implementation of clinical policies and protocols related to substance use disorder.
• Provide expert guidance on evidence-based treatment options and best practices in SUD care.
• Champion the integration of physical and behavioral health.
• Provides oversight and direction for SUD-related utilization management and care management activities.
• Works with physician and clinical leadership teams to ensure consistent, evidence-based medical decision-making for all physician reviewers.
• Provide consultative support on a routine basis to NH Medicaid Care Management, including but not limited to, clinical policy related to SUD and individual Member cases, as needed.

* Program Development:

o Lead the design and evaluation of SUD programs, including prevention, intervention, and treatment strategies.

o Collaborate with multidisciplinary teams to enhance care coordination and member engagement.

• Quality Improvement:




• Monitor and analyze clinical outcomes and quality metrics related to SUD services.
• Implement quality improvement initiatives to enhance treatment effectiveness and member satisfaction.
• Leads and/or participates in quality committees related to SUD.




• Education and Training:




• Develop and conduct training programs for clinical staff on SUD diagnosis, treatment, and management.
• Foster a culture of learning and continuous improvement within the organization.




• Stakeholder Collaboration:




• Primarily devoted to WellSense membership in New Hampshire.
• Active meeting participation, and at least yearly, meetings with organizations that support persons with SUD, including OTPs, hospitals, harm reduction organizations, The Doorway program sites, CMHCs, sober living homes, and other non-profit and for-profit organizations assisting persons with SUD.
• Represent the health plan in professional meetings and forums related to substance use disorder.
• Provides direct point of contact for clinical concerns or escalations related to SUD services and member needs.

* Policy and Compliance:

o Ensure that SUD programs comply with local, state, and federal regulations.

o Stay informed about changes in policies affecting substance use disorder treatment and advocate for appropriate health plan responses.

* Budget Support:

o Provides leadership and direction to ensure the most appropriate utilization of company resources in executing organizational and departmental goals and objectives, including evaluation with business owners of appropriate resource allocation, priority, and timeline.

o Identifies opportunities for cost savings without compromising quality or operational efficiency.

Supervision Exercised:

* Directly or indirectly oversees management of clinical and non-clinical staff.

Supervision Received:

* General supervision received weekly.

Qualifications:

Education:

* Medical degree (MD or DO) with active medical license (New Hampshire required).

* Board Certification in Addiction Medicine, Psychiatry, or a related field.

Preferred/Desirable:

* Active medical license in Massachusetts.

Experience:

* A minimum of 10 years of progressive experience in managed care or similar health care environment, including experience in developing and executing strategic business plans and budgets with a record of achieving results.

* A minimum of 5 years of clinical experience in SUD treatment.

* Previous experience in a leadership role within a health plan or healthcare organization preferred.

* Strong understanding of healthcare policies, regulations, and best practices related to SUD.

Certification or Conditions of Employment:

* Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

* Excellent communication, interpersonal, and leadership skills.

* Excellent relationship and consensus-building skills.

* Ability to multi-task, prioritize, and deliver in a demanding and constantly changing environment.

* Demonstrated ability to successfully plan, organize and manage programs and projects.

* Strong independent judgment, critical and analytical thinking, and decision-making skills required.

Working Conditions and Physical Effort:

• Regular and reliable attendance is essential.
• Fast paced environment.
• No or limited physical effort required.
• No or limited exposure to physical risk.
• Must maintain an in-state and/or in person presence in New Hampshire of at least 50% FTE.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees