Enterprise Medical Director – Behavioral Health
CareSource
full-time
Posted on:
Location Type: Remote
Location: Ohio • United States
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Salary
💰 $195,200 - $341,600 per year
Job Level
About the role
- Responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing
- Support Ohio Behavioral Health Market team program design and development and strengthening community collaboration
- Supervise part time Behavioral Health Medical Directors
- Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
- Assume key role in quality improvement initiatives, case management activities and member safety activities
- Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
- Provide provider education, training, data sharing, performance evaluations and orientation to the plan
- 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
- Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
- 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
- Provide prior authorization medical reviews, consultation, and clinical review services
- Conduct clinical reviews for designated CareSource members
- Identify utilization management trends and take appropriate action
- Support market provider network development and maintenance Clinical Appeals
- Participate in peer-to-peer discussions
- Support staff by providing training, clinical consultation, and clinical case review for members
- 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 five (5) years of clinical practice experience
- Clinical SUD/MAT experience is preferred
- Managed care medical review/medical director experience is preferred
- Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred
- Basic Microsoft Word skills
- 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 (exceptions may be granted by Chief Medical Officer)
- MCG Certification is required or must be obtained within six (6) months of hire
Benefits
- Bonuses tied to company and individual performance
- Substantial and comprehensive total rewards package
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical practicepsychiatryclinical SUD/MAT experiencemanaged care medical reviewquality improvement initiativesutilization managementevidence-based clinical policiescase managementclinical review servicesprovider education
Soft Skills
leadershipcollaborationcommunicationtrainingsupervisionproblem-solvinganalytical skillsperformance evaluationconsultationcross-coverage
Certifications
Medical Degree (MD or DO)Board Certification in psychiatryMCG Certificationcurrent medical licenseresidency training in psychiatry