Senior Medical Director, Behavioral Health

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 Senior Medical Director for Behavioral Health (BH) is responsible for leading initiatives aimed at enhancing the quality and accessibility of mental health and substance use disorder (SUD) services for our members. In partnership with our BH team, will provide strategic direction, clinical oversight, and leadership in the development and implementation of comprehensive behavioral health programs.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

• Strategic Leadership and Clinical Oversight:




• Collaboratively develop and execute a strategic vision for behavioral health services that aligns with the overall goals of the health plan.
• Oversee the development and implementation of clinical policies and protocols related to BH and SUD, including utilization management and care management related Plan activities.
• Provide expert guidance on evidence-based treatment options and best practices in SUD care.
• Work with executive leadership to integrate BH/SUD into overall health plan initiatives and programs.
• Champion the integration of physical and behavioral health
• Provide clinical leadership and oversight for BH/SUD services, ensuring adherence to evidence-based practices and regulatory requirements.
• Monitor the effectiveness and quality of BH/SUD programs and services, implementing necessary improvements.

* Program Development and Management:

o Design and oversee innovative BH/SUD programs that address the diverse needs of our member population, including prevention, intervention, and treatment strategies.

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

• Quality Improvement:




• Partnering with our Quality and BH teams, lead quality assurance initiatives to monitor clinical outcomes and member satisfaction within BH/SUD services.
• Monitor and analyze clinical outcomes and quality metrics related to BH/SUD services.
• Implement quality improvement initiatives to enhance treatment effectiveness and member satisfaction.
• Utilize data and analytics to drive quality improvement efforts and enhance service delivery.




• Education and Training:




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




• Stakeholder Collaboration:




• Engage with external partners, including community organizations, health care providers, and regulatory agencies, to strengthen and improve access to BH/SUD services.
• Represent the health plan in professional meetings and forums related to BH/SUD and engage in advocacy efforts to promote mental health awareness.
• Engages with key system teams including, but not limited to, Population Health and the BMC Department of Psychiatry.

* Policy and Compliance:

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

o Stay informed about trends and changes in policies affecting BH/SUD treatment and advocate for appropriate health plan responses.

* Budget Management:

o Develops and manages the budget for BH/SUD physician resources required by the Plan to efficiently meet clinical operation needs.

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 an active, unrestricted medical license and/or the ability to obtain unrestricted licensure within a reasonable period of time, is required (in both Massachusetts and New Hampshire).

* Board Certification in Psychiatry.

Preferred/Desirable:

* Dual certification in Psychiatry and Addiction Medicine.

* Board Certification in Child & Adolescent Psychiatry

Experience:

* A minimum of 5 years of progressive experience in managed care or similar health care environment, including significant leadership and team management experience.

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

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

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