Behavioral Health Medical Director- Child Psychiatrist at Elevance Health

Walnut Creek, California, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Behavioral HealthIndustries

Requirements

MD or DO degree
Board certification approved by American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), where applicable to duties
Active unrestricted medical license to practice medicine or a health profession in the state of California
Must be located in a state or territory of the United States when conducting utilization review or appeals (unless expressly allowed by state/federal law/regulation); cannot be on US military base, vessel, or embassy
Minimum of 10 years of clinical experience, or equivalent combination of education and experience
For Health Solutions and Carelon organizations (including behavioral health), minimum of 5 years of experience providing health care (additional experience may be required by state contracts/regulations)

Responsibilities

Complete medical necessity reviews for general child psychiatry cases and Applied Behavioral Analysis cases supporting commercial and Medicaid business lines
Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients’ office visits
Apply clinical knowledge and skills to utilization review processes
Adhere to medical policies and clinical guidelines
As assigned, engage in clinical and non-clinical activities that impact health care quality, cost, and outcomes
If requested, provide guidance for clinical operational aspects of a program
May serve on internal and/or external committees
May develop and propose new medical policies based on changes in healthcare
Identify and develop opportunities for innovation to increase effectiveness and quality

Skills

Child Psychiatry

Medical Necessity Review

Utilization Review

Peer-to-Peer Review

Applied Behavioral Analysis

ABA

Clinical Guidelines

Medical Policies

Board Certification

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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