Behavioral Health Medical Director

CareSource • Dayton, OH

5d • $195,200 - $341,600 • Hybrid

About The Position

The Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing. This role serves as the psychiatric lead in developing and implementing evidenced based clinical BH policies and practices for the state. The director will oversee BH coverage determination, lead quality improvement initiatives, and act as the primary psychiatric liaison to members, providers, and state agencies. They will also contribute to the development of clinical care standards, quality improvement plans, and collaborate with market leaders to enhance BH services. Additionally, the role involves evaluating cases of suspected fraud, abuse, and quality of care concerns, providing cross-coverage, and supporting staff through training and consultation. The Medical Director will advocate for behavioral health, strengthen provider relationships, and engage in professional society activities. They will consult with leadership to improve quality through collaborative execution of behavioral health quality improvement activities, including HEDIS and value-based reimbursement contracting. The position requires acting as a liaison with state agencies and organizations on BH initiatives, and potentially residing in the state market if required. Any other job-related duties as requested will also be performed.

Requirements

• Medical Doctor (MD) required or Doctor of Osteopathic Medicine (DO) required
• Successful completion of a residency training program in psychiatry required
• Five (5) years of clinical practice experience required
• Experience in safe prescribing required
• Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements required
• Board Certification in Psychiatry required
• Re-certification, as required by specialty board, must be maintained
• MCG Certification is required or must be obtained within six (6) months of hire
• Basic Microsoft Word skills
• Excellent communication skills, both written and oral
• Ability to work well independently and within a team environment
• Ability to create strong relationships with Providers and Members
• High ethical standards
• Attention to detail
• Critical listening and systematic thinking skills
• Ability to maintain confidentiality and act in the company’s best interest
• Ability to act with diplomacy and sensitivity to cultural diversity
• Decision making/problem solving skills
• Conflict resolution skills
• Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
• Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns
• Leadership experience and skills

Nice To Haves

• Managed care medical review/medical director experience preferred
• Residence and clinical practice in assigned market may be required preferred
• Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred

Responsibilities

• Assume responsibility for the overall safety of patients with a behavioral health (BH) diagnosis, focusing on safe prescribing practices
• Serve as the psychiatric lead in developing and implementing evidenced based clinical BH policies and practices for the state
• Conduct regulatory and accreditation reviews to ensure compliance with applicable standards
• Oversee BH coverage determination for utilization management, ensuring members receive appropriate and medically necessary care in the most cost-effective setting
• Lead quality improvement initiatives, case management activities and member safety protocols, including incident management
• Review utilization data to identify variances in patterns and provide feedback and education to Managed Care Plan (MCP) staff and providers as needed
• Represent CareSource as the primary psychiatric liaison to members, providers and state agencies
• Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
• Contribute to the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
• Collaborate with market and product leaders to define market strategy and enhance the quality and affordability of BH services
• Participate in community collaborative initiatives to improve BH services
• Evaluate and investigate cases suspected of fraud, abuse, and quality of care concerns
• Provide cross-coverage for other Medical Directors and/or markets, as needed
• Support staff through training, clinical consultation, and clinical case review for members, including Medical Advisement meetings
• Advocate for behavioral health in collaboration with the Market's government affairs and regulatory leads to advance CareSource's mission and meet specific advocacy goals
• Strengthen and develop relationships with specialty (CBHC) and IMD (standalone hospital) providers as needed in the Market
• Engage in Market professional society activities to enhance CareSource's objectives
• Consult with Market and Enterprise leadership to improve quality for members through collaborative execution of behavioral health quality improvement activities, including HEDIS and value-based reimbursement contracting
• Act as liaison with state agencies and organizations on BH initiatives, residing in the state market if required
• Perform any other job related duties as requested.

Benefits

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree