Behavioral Health Medical Director
- Blue Shield of California
- | Millbrae, CA
$192,317 per year |
OTHER |
July 24th, 2025
-
Blue Shield of California -
Millbrae, CA
-
$192,317 per year
-
OTHER
-
July 24th, 2025
Your Role
The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
- Review concurrent, pre- and post-service behavioral health service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP (Federal Employee Program) medical policy, as well as legal and regulatory requirements
- Medical decision and support for the behavioral health review for all services currently requiring authorization or review, facilitating appropriate use of all resources, including safe and timely discharges
- Engage in telephonic peer-to-peer discussions regarding current members in various levels of care or who may be receiving other specialized services. Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providers
- Train BSC utilization and care management staff which may include physicians, psychologists, nurses, social workers, and others as needed
- Perform clinical reviews to support utilization management and fraud waste and abuse case evaluations
- Participate with the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes for our members
- Participate on projects and committees, as necessary
Your Knowledge and Experience
- Minimum 5 years direct patient behavioral health clinical care experience post residency required
- Medical degree (M.D./D.O.)
- Completed residency in Psychiatry
- Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
- Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required
Preferred Qualifications:
- Recent inpatient psychiatric hospital experience (within the past five years)
- Recent substance use disorders treatment experience (within the past five years)
- Well-versed with most areas of behavioral health services and conditions
- Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues
- Experience with CPT coding, medical claims review, hospital billing, and reimbursement
- Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
- Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health
- Experience with ASAM, LOCUS, CALOCUS, and WPATH
Subscribe for Latest Jobs
Get job updates directly to your inbox.
Share This job
Spread the word through your favorite platforms.
Similar Jobs
Your RoleThe Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the...
At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. Everywhere. Every day. It's a lofty goal; we know. But we make it happen with the best...
Anders Group is seeking a travel Home Health Physical Therapist for a travel job in Hesperia, California.Job Description RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: 08/11/2025Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelAnders Group Job ID #904935. Pay package is based on 8 hour shifts and 40 hours per...
Adventist Health is seeking a Home Health Physical Therapist for a job in Sonora, California.Job Description RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: ASAPDuration: OngoingEmployment Type: StaffOur home health and hospice agencies are located throughout California, Hawaii, Oregon and Washington. They serve the entire community and o...
Focus Staff is seeking a travel Rehabilitation Therapist for a travel job in San Ramon, California.Job Description RequirementsSpecialty: Rehabilitation TherapistDiscipline: TherapyStart Date: 08/18/2025Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelFocus Staff is seeking a Physical Therapist for a travel contract in San Ramon, CA....
Ardor Health Solutions is seeking a travel Occupational Therapist for a travel job in San Ramon, California.Job Description RequirementsSpecialty: Occupational TherapistDiscipline: TherapyStart Date: 08/04/2025Duration: 26 weeks40 hours per weekShift: 8 hours, daysEmployment Type: Travel Location: SAN RAMON, CA Setting: HOME HEALTH Employment Type: Traveler Ar...
Core Medical Group is seeking a travel Physical Therapist for a travel job in Santa Maria, California.Job Description RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: 07/25/2025Duration: 13 weeks40 hours per weekShift: 8 hoursEmployment Type: TravelClient in CA seeking Physical Therapistfor the following shift(s): DaysWe are looking for a ...
Synergy Medical Staffing is seeking a travel Physical Therapist for a travel job in El Centro, California.Job Description RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelTravel, PT - RehabLocation: El Centro, CaliforniaShift: 5x8 Days, 08:00:00-16:00:00, 8.0...
Coast Medical Service is seeking a travel Physical Therapist for a travel job in San Ramon, California.Job Description RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelCoast Medical Service is a nationwide travel nursing allied healthcare staffing agency ded...
High-Volume Searches
- Medical Director jobs
- Medical Director jobs near Millbrae, CA
- Medical Director jobs Millbrae, CA
- Medical Director jobs hiring near Millbrae, CA
- Medical Director jobs in Millbrae, CA
- Medical Director jobs near me
Blue Shield of California Searches
- Blue Shield of California jobs
- Blue Shield of California jobs near Millbrae, CA
- Blue Shield of California jobs hiring near Millbrae, CA
- Blue Shield of California jobs in Millbrae
- Blue Shield of California jobs near me
- Blue Shield of California careers
- Blue Shield of California vacancies
Geographic Searches
- Blue Shield of California Medical Director jobs near Millbrae, CA
- Behavioral Health Medical Director jobs near Millbrae, CA
- Behavioral Health Medical Director jobs hiring near me Millbrae, CA
- Behavioral Health Medical Director jobs in Millbrae
- Behavioral Health Medical Director jobs near me
Searches you may like:
- Part Time Rn Jobs Near Me
- Nearby Hospital Jobs
- Jobs Near Me
- Hospitals Hiring Near Me
- Healthcare Jobs Near Me
Explore opportunities in nearby cities:
- Home Health Physical Therapist Jobs Near Alameda, CA
- Behavioral Health Medical Director Jobs Near Alamo, CA
- Travel Home Health Physical Therapist Jobs Near Albany, CA
- Travel Home Health Occupational Therapist Jobs Near Belmont, CA
- Psychiatric Mental Health Nurse Practitioner - Emeryville, CA Jobs Near Belvedere Tiburon, CA