Behavioral Health Medical Director- Psychiatrist - Part-time

Elevance Health•Iselin, NJ

1d•Remote

About The Position

The Behavioral Health Medical Director oversees the administration of behavioral health services to ensure members receive appropriate, high-quality, and cost-effective care. This role provides clinical consultation and strategic guidance to strengthen clinical operations, supports the design and implementation of initiatives that improve quality, outcomes, and affordability, and identifies cost-of-care opportunities. The Medical Director also serves as a clinical resource to staff, including Medical Director Associates, and may have accountability for an entire clinical program. We are seeking a psychiatrist for this position to complement and expand the capabilities of our behavioral health team, working alongside an existing PhD psychologist medical reviewer. The role will part-time and will initially work 10 hours per week, with some weekend coverage as needed.

Requirements

MD/DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
Must possess an active unrestricted medical license to practice medicine or a health profession.
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.
Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a state agency.
For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Current VT, DE, WY, AR, MS, NM license or willingness to apply for licensing in these states if needed.
Utilization Management experience.

Responsibilities

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.
Represent the company to external entities and/or serve on internal and/or external committees.
Chair company committees.
Interprets medical policies and clinical guidelines.
Develops and proposes 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.
The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and overseeing clinical/non-clinical activities.
Attendance at Behavioral Health interdisciplinary team (IDT) meetings.
Attend and participate in other team-related meetings with regularity (monthly, quarterly).