Behavioral Health Medical Director

CareSource•Dayton, OH

1d•$195,200 - $341,600•Hybrid

About The Position

The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. This role serves as the clinical lead in developing and implementing evidence-based clinical policies and practices, participating in regulatory/accreditation reviews, and taking a key role in quality improvement initiatives, case management activities, and member safety activities. The position also involves BH coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting, and provides oversight and quality improvement activities associated with case management. Additionally, the role offers guidance to BH orientation and network development/recruitment, supports value-based contracting and integration of BH services, and assists in reviewing utilization data to identify variances and provide feedback. The Behavioral Health Medical Director represents CareSource as the primary clinical liaison to members, providers, and State agencies, supports regulatory and accreditation functions, and participates in the development, implementation, and revision of clinical care standards, practice guidelines, and the Quality Improvement Plan. Collaboration with market/product leaders, community engagement, and participation in the evaluation of fraud, abuse, and quality of care concerns are also key aspects of this position. Cross-coverage for other Medical Directors and providing staff support through training, clinical consultation, and case review are expected.

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 three (3) years of clinical practice experience is required
Experience in safe prescribing is required
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
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 is preferred
Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred

Responsibilities

Assume responsibility for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing
Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
Participate in regulatory/accreditation reviews
Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
BH coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting
Oversight and quality improvement activities associated with case management activities
Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
Represent CareSource as the primary clinical liaison to members, providers and State agencies
Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
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
Community collaborative participation
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
Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
Perform any other job duties as requested