Behavioral Health Medical Director
CareSource
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $195,200 - $341,600 per year
Job Level
Lead
About the role
- 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
Requirements
- 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
- Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
- Board Certification in Psychiatry is required
- MCG Certification is required or must be obtained within six (6) months of hire
Benefits
- health insurance
- retirement plans
- paid time off
- bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
safe prescribingclinical policiesquality improvementcase managementutilization managementclinical care standardsclinical consultationfraud investigationdata analysisclinical case review
Soft skills
leadershipcommunicationcollaborationguidancetrainingproblem-solvinginterpersonal skillsorganizational skillsfeedback provisioncommunity participation
Certifications
Medical Degree (MD or DO)Board Certification in PsychiatryMCG Certification