Vice President

2 weeks ago

Dubai, United Arab Emirates Health eCareers Full time

JobSummary

The Medical Director,Mental Health and Wellness (MHW) is a leader within the nationalprogram office responsible for Health Plan quality oversight,ensuring all members and patients in the California markets seekingmental health and wellness services receive high quality, excellentcare and service, delivered in compliance with laws andregulations. The Mental Health and Wellness portfolio is inclusiveof the continuum of emotional, psychological and psychiatric healthas well as Autism care and psychological elements of TransgenderCare. This leader will leverage extensive clinical and medicalexpertise in mental health and wellness to identify areas of riskand care gaps to improve the clinical outcomes for KaiserPermanente patients and members. The MHW Medical Director willprovide clinical and medical expertise to create and/or maintainevidence-based practices and serve as a subject matter, medicalexpert and advisor to legal counsel and the Kaiser FoundationHealth Plan and Hospitals Board of Directors in surfacing issuesand creating and/or reviewing system-wide changes to mental healthcare services. The incumbent in the position will design, directand implement the Mental Health and Wellness Quality AssuranceProgram, a program that will ensure performance across allCalifornia mental health units is routinely monitored, documented,and issues are escalated appropriately. The MHW Medical Directorwill work with appropriate Health Plan departments to deployassessments on relevant behavioral and mental healthareas/functions and to ensure care providers follow statutorytimelines, laws, and regulations. The position will report directlyto the Executive Vice President, Chief Medical Officer, Health Planand Hospitals Quality with a dotted line to the Northern andSouthern California markets- Vice Presidents of Safety, Quality& Regulatory Services to ensure coordination, collaborationand quality protection as needed. This position will have frequentinteractions with national and local executives and leaders,regional KFH/HP,TPMG and SCPMG executives and other regionalpartners (Quality, Legal,etc.).

EssentialResponsibilities

  • Under the direction of the ExecutiveVice President, Chief Medical Officer and matrixed direction fromthe Northern and Southern California markets- Vice Presidents ofSafety, Quality, and Regulatory Services, and in collaboration withkey KFH/HP stakeholders, SCPMG and TPMG partners, the MHW MedicalDirector will:
  • Provide strategic, medical andclinical expertise to Kaiser Permanente Behavioral and MentalHealth teams to identify and resolve complex and cross-functionaloperational issues associated with access and quality of care. Thisrequires initiating, leading, coordinating, and supporting a broadrange of regional strategies to achieve industry-leading quality,service, patient safety, and riskmanagement.
  • Develop the California MentalHealth and Wellness Quality Oversight program strategy incoordination with the National, Northern California and SouthernCalifornia quality and mental health and wellnessteams.
  • Understand global, national and statetrends and emerging methods that inform the development anddeployment of performance reporting systems and oversight processesto surface relevant performance issues in a timely manner,including development of appropriate metrics required to strengthenthe performance of Mental Health and Wellness in partnership withCalifornia market leadership.
  • Perform medicalcase review for quality and risk evaluation and surfaceopportunities for improvement and considerations for peerreview.
  • Develop, deploy and manage acomprehensive system for monitoring and evaluating access andnetwork adequacy, including policies and procedures for identifyingand addressing problems with operational leaders that maydevelop.
  • Co-chair the Behavioral Health QualityOversight Committees (BHQOC), subcommittees of the regional KPNorthern California Quality Oversight Committee and KP SouthernCalifornia Quality Committee. The Mental Health and WellnessMedical Director will also serve as a voting member on both the KPNorthern California Quality Oversight Committee and the SouthernCalifornia Quality Committee which report to the Board Quality andHealth Improvement Committee (QHIC).
  • Provideinput for the Mental Health and Wellness Joint Operational NorthernCalifornia and Statewide committees.
  • Incollaboration with Legal, Compliance, and regional leadership, theMental Health and Wellness Medical Director will be responsible forproviding leadership and promoting compliance with all applicablelegal and regulatory requirements related to the provision ofmental health and wellness services to Kaiser Permanente membersand patients.
  • Partner with Member Services andExperience leadership to surface and resolve issues related tomember mental health services experience, complaints and grievancesand denials.
  • Provide consultation, guidance andassure compliance with regulatory standards associated with thereview of appeals, denials and Independent Medical Review (IMR) andshare lessons learned.
  • Contribute to theregional policies, procedures, and practices for mental health andwellness policies. Develop and/or advise on new policies andprocedures, as needed.
  • Partner with nationalcolleagues on Non-Quantitative Treatment Limits (NQTL) comparativeanalyses.
  • Actively look to find synergies andbest practices with colleagues in California and in other KPmarkets. Regularly perform external scans for best practices andbenchmark performance.

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