Behavioral Health Medical Director with Aetna Better Health of New Jersey

The Behavioral Health Medical Director is a key position on Aetna Better Health of NJ’s (ABHNJ) leadership team and is responsible for leadership and counsel for utilization management and case management programs for mental health and substance use disorder services and collaboration with DMAHS, and other state agencies, to oversee the implementation of BH integration efforts. Successful candidate must live in New Jersey or be willing to relocate.

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Responsibilities include: • Participation in the development of clinical practice standards, policies, and procedures • Behavioral health care management performance and coordination with physical health care management • Participation in DMAHS and other agency/stakeholder meetings when requested • Oversight and implementation of the utilization management program for behavioral health services, including preventing contraindicated care • Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities • Overseeing the complaint and grievance process for behavioral health denials, • Review and resolution of quality-of-care concerns • Provide strategic oversight and leadership for all behavioral health activities within the health plan. • Serve as the subject matter expert on behavioral health for ABHNJ, ensuring compliance and alignment with state regulations and expectations. • Lead and coordinate efforts with the state and other health plan colleagues to promote integrated care models. • Oversee coordination activities with the state, ensuring effective collaboration and adherence to regulatory requirements. • Work closely with health plan leadership, the Chief Medical Officer, other Medical Leadership, Pharmacy Director, clinical staff (including those in utilization management, care management, quality management), and colleagues within network and provider relations, to enhance the delivery of holistic and integrated care. • Contribute to the development and implementation of policies and procedures that support the health plan's objectives and comply with state guidelines. • Advocate for and implement innovative approaches to behavioral health care, promoting evidence-based practices that enhance patient outcomes. • Support duties as required regarding utilization management of the service benefit and pharmacy benefit within the state health plan and additional duties as assigned.

Required Qualifications • Significant clinical experience in the treatment of substance use disorders, including utilization of ASAM criteria, and an understanding of the New Jersey system of care. • At least five years combined experience in mental health and substance use services and at least two (2) years of BH leadership experience in a government, health management, or managed care organization, and/or at least two (2) years of experience as a Medical Director in clinical practice, and/or at least three (3) years of clinical BH experience (excluding psychiatric residency). • Experience with NJ Medicaid behavioral health benefits and service • Ability to effectively interact with providers, advocacy groups and State partners • Excellent organization and time management skills • Experience navigating a matrixed organization. • NJ Medicaid regulatory experience

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Education

Board-certified psychiatrist licensed in the State of New Jersey.