Vice President

Job Summary

The Medical Director, Mental Health and Wellness (MHW) is a leader within the national program office responsible for Health Plan quality oversight, ensuring all members and patients in the California markets seeking mental health and wellness services receive high quality, excellent care and service, delivered in compliance with laws and regulations. The Mental Health and Wellness portfolio is inclusive of the continuum of emotional, psychological and psychiatric health as well as Autism care and psychological elements of Transgender Care. This leader will leverage extensive clinical and medical expertise in mental health and wellness to identify areas of risk and care gaps to improve the clinical outcomes for Kaiser Permanente patients and members. The MHW Medical Director will provide clinical and medical expertise to create and/or maintain evidence-based practices and serve as a subject matter, medical expert and advisor to legal counsel and the Kaiser Foundation Health Plan and Hospitals Board of Directors in surfacing issues and creating and/or reviewing system-wide changes to mental health care services. The incumbent in the position will design, direct and implement the Mental Health and Wellness Quality Assurance Program, a program that will ensure performance across all California mental health units is routinely monitored, documented, and issues are escalated appropriately. The MHW Medical Director will work with appropriate Health Plan departments to deploy assessments on relevant behavioral and mental health areas/functions and to ensure care providers follow statutory timelines, laws, and regulations. The position will report directly to the Executive Vice President, Chief Medical Officer, Health Plan and Hospitals Quality with a dotted line to the Northern and Southern California markets- Vice Presidents of Safety, Quality & Regulatory Services to ensure coordination, collaboration and quality protection as needed. This position will have frequent interactions with national and local executives and leaders, regional KFH/HP,TPMG and SCPMG executives and other regional partners (Quality, Legal, etc.).

Essential Responsibilities

• Under the direction of the Executive Vice President, Chief Medical Officer and matrixed direction from the Northern and Southern California markets- Vice Presidents of Safety, Quality, and Regulatory Services, and in collaboration with key KFH/HP stakeholders, SCPMG and TPMG partners, the MHW Medical Director will:
• Provide strategic, medical and clinical expertise to Kaiser Permanente Behavioral and Mental Health teams to identify and resolve complex and cross-functional operational issues associated with access and quality of care. This requires initiating, leading, coordinating, and supporting a broad range of regional strategies to achieve industry-leading quality, service, patient safety, and risk management.
• Develop the California Mental Health and Wellness Quality Oversight program strategy in coordination with the National, Northern California and Southern California quality and mental health and wellness teams.
• Understand global, national and state trends and emerging methods that inform the development and deployment of performance reporting systems and oversight processes to surface relevant performance issues in a timely manner, including development of appropriate metrics required to strengthen the performance of Mental Health and Wellness in partnership with California market leadership.
• Perform medical case review for quality and risk evaluation and surface opportunities for improvement and considerations for peer review.
• Develop, deploy and manage a comprehensive system for monitoring and evaluating access and network adequacy, including policies and procedures for identifying and addressing problems with operational leaders that may develop.
• Co-chair the Behavioral Health Quality Oversight Committees (BHQOC), subcommittees of the regional KP Northern California Quality Oversight Committee and KP Southern California Quality Committee. The Mental Health and Wellness Medical Director will also serve as a voting member on both the KP Northern California Quality Oversight Committee and the Southern California Quality Committee which report to the Board Quality and Health Improvement Committee (QHIC).
• Provide input for the Mental Health and Wellness Joint Operational Northern California and Statewide committees.
• In collaboration with Legal, Compliance, and regional leadership, the Mental Health and Wellness Medical Director will be responsible for providing leadership and promoting compliance with all applicable legal and regulatory requirements related to the provision of mental health and wellness services to Kaiser Permanente members and patients.
• Partner with Member Services and Experience leadership to surface and resolve issues related to member mental health services experience, complaints and grievances and denials.
• Provide consultation, guidance and assure compliance with regulatory standards associated with the review of appeals, denials and Independent Medical Review (IMR) and share lessons learned.
• Contribute to the regional policies, procedures, and practices for mental health and wellness policies. Develop and/or advise on new policies and procedures, as needed.
• Partner with national colleagues on Non-Quantitative Treatment Limits (NQTL) comparative analyses.
• Actively look to find synergies and best practices with colleagues in California and in other KP markets. Regularly perform external scans for best practices and benchmark performance.