Behavioral Health Medical Director responsible for behavioral health services for California Medicaid members. Reviewing cases and providing clinical consultation while ensuring quality care outcomes.
About the role
- Medical Director overseeing risk adjustment strategy at CareMore Health. Leading provider education and ensuring compliance with CMS requirements.
Responsibilities
- Serve as the clinical expert responsible for advancing CareMore Health’s risk adjustment strategy.
- Guide providers in accurate and complete documentation of patient complexity and chronic conditions.
- Ensure compliance with CMS requirements while supporting enterprise revenue integrity.
- Focus on healthcare provider education, data-driven interventions, and cross-functional collaboration with coding, analytics, and operations teams.
- Partner closely with coding, compliance, analytics, and operations teams to integrate risk adjustment into broader CareMore and Mosaic Health initiatives.
Requirements
- MD or DO required, with active, unrestricted medical license.
- Board certification in Internal Medicine, Family Medicine, or related specialty strongly preferred.
- 8+ years of clinical practice experience, with at least 3–5 years in an expert-level role involving risk adjustment, clinical documentation improvement (CDI), or value-based care.
- Demonstrated success leading provider education and engagement programs to improve coding and documentation.
- Experience with Medicare Advantage and CMS risk adjustment methodology (HCC coding, RAF scoring, RADV audits).
Benefits
- Health insurance
- Professional development opportunities
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