Behavioral Health Medical Director, Psychiatrist
Elevance Health
Supervisory Medical Director
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States • Missouri
Visit company websiteSalary
💰 $231,900 - $440,500 per year
Job Level
Lead
About the role
- Plays a critical role delivering medical, people leadership and expertise to ensure high-quality, cost-effective care to members
- Assist Senior Medical Director or Chief Medical Officer in execution of strategic clinical initiatives
- Provide people leadership, coaching and mentorship for a team of front-line medical directors, including scheduling Utilization Management coverage, annual goal development, monthly 1:1s, mentorship/career development, and annual evaluations
- Participate in utilization review studies, evaluate adverse trends, and collaborate to develop solutions
- Handle complex and high-profile utilization management cases, ensuring timely and appropriate decision-making
- Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams
- Conduct and participate in peer-to-peer reviews with healthcare providers to resolve disputes and implement recommendations
- Oversee and actively participate in the appeals process, ensuring compliance with regulatory requirements
- Provide clinical guidance to care managers and support development of individualized care plans
- Represent the business unit before publics and state/ad hoc committees as needed
- Collaborate closely with clinical teams, appeals team, and network providers
- Perform other duties as assigned and comply with all policies and standards
Requirements
- Medical Doctor (MD) — Graduate of an accredited medical school required
- Master's Degree (MBA, MPH, or epidemiologist degree) preferred
- 5+ years Managed care/clinical experience; experienced with commercial, Medicare and Medicaid lines of business required
- 1+ years Supervisory/management experience preferred
- Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services required
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required
- Experience providing people leadership, coaching and mentorship for clinical staff
