Medical Director
Humana
Behavioral Health Medical Director- Psychiatrist – MyCare Ohio
Elevance Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Ohio
Visit company websiteJob Level
Lead
About the role
- The Behavioral Health Medical Director- Psychiatrist is responsible for the administration of behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received.
- May be responsible for developing and implementing programs to improve quality, cost, and outcomes.
- May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.
- May be responsible for an entire clinical program.
- Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions.
- Supports clinicians to ensure timely and consistent responses to members and providers.
- Provides guidance for clinical operational aspects of a program.
- Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office visits with providers and external physicians.
- Serves as a resource and consultant to other areas of the company.
- May be required to represent the company to external entities and/or serve on internal and/or external committees.
- May chair company committees.
- Interprets medical policies and clinical guidelines.
- May develop and propose new medical policies based on changes in healthcare.
- Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
Requirements
- MD or DO and Board certification approved by ABMS or AOA
- Must possess an active unrestricted medical license to practice medicine or a health profession in Ohio
- Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US
- Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
- For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required
- Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency
- Must be a resident of Ohio
