Behavioral Health Medical Director
Dayton WFH, United States
Job Summary:
The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing.
Essential Functions:
- Assume responsibility for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing
- Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
- Participate in regulatory/accreditation reviews
- Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
- BH coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting
- Oversight and quality improvement activities associated with case management activities
- Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
- Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
- Represent CareSource as the primary clinical liaison to members, providers and State agencies
- Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
- Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
- Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
- Collaborate with market/product leaders to help define market strategy
- Community collaborative participation
- Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
- Provide cross-coverage for other Medical Directors and/or markets, as needed
- Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
- Perform any other job duties as requested
Education and Experience:
- Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
- Successful completion of a residency training program in psychiatry is required
- Minimum of three (3) years of clinical practice experience is required
- Experience in safe prescribing is required
- Managed care medical review/medical director experience is preferred
Competencies, Knowledge and Skills:
- Basic Microsoft Word skills
- Excellent communication skills, both written and oral
- Ability to work well independently and within a team environment
- Ability to create strong relationships with Providers and Members
- Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred
- High ethical standards
- Attention to detail
- Critical listening and systematic thinking skills
- Ability to maintain confidentiality and act in the company’s best interest
- Ability to act with diplomacy and sensitivity to cultural diversity
- Decision making/problem solving skills
- Conflict resolution skills
- Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
- Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns
- Leadership experience and skills
Licensure and Certification:
- Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
- Board Certification in Psychiatry is required
- Re-certification, as required by specialty board, must be maintained
- MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- May be required to work evenings/weekends
- May be required to travel in-state to fulfill duties of position
Compensation Range:
$191,400.00 - $334,900.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies
Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
ApplyJob Profile
Comprehensive total rewards package General office environment Inclusive environment
Tasks- Analyze
- Analyze utilization data
- Case review
- Collaborate
- Conduct regulatory reviews
- Develop clinical policies
- Maintain confidentiality
- Oversee patient safety
- Participate in quality improvement
- Provide clinical guidance
Accreditation Attention to detail Behavioral health Case Management Certification Clinical Care Clinical care standards Clinical Leadership CMS Communication Compliance Conflict Resolution Contracting Critical Listening Decision making Healthcare Healthcare data analysis Integration Leadership Managed Care Management Market strategy Microsoft Word NCQA Network Organization Provider Relations Quality improvement Recruitment Regulatory Regulatory requirements Resolution SAFe Safe Prescribing Systematic Thinking Training URAC Utilization management Word
Experience3 years
EducationBusiness DO Doctor of Osteopathic Medicine Equivalent Healthcare Medical degree Medical doctor Residency in Psychiatry Residency training
CertificationsBoard Certification Board Certification in Psychiatry Mcg certification
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9