Clinical Psychologist

CareSource•Dayton, OH

3d•$94,100 - $164,800•Onsite

About The Position

The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting. This role involves serving 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 includes oversight of quality improvement activities associated with case management, providing guidance to behavioral health orientation and network development/recruitment, and assisting in the review of utilization data. The Clinical Psychologist will act as the primary clinical liaison to members, providers, and State agencies, supporting regulatory and accreditation functions and ensuring compliance for all programs. Additionally, this role participates in the development, implementation, and revision of clinical care standards, practice guidelines, and the Quality Improvement Plan, while collaborating with market/product leaders on market strategy and community initiatives. The position also involves evaluating and investigating cases of suspected fraud, abuse, and quality of care concerns, and providing cross-coverage for Behavioral Health Medical Directors as needed. Support is provided to staff through training, clinical consultation, and clinical case review, including Medical Advisement meetings. The role also includes performing any other job-related instructions as requested.

Requirements

Completion of an accredited clinical psychology program is required
Successful completion of a doctoral internship program in psychology is required
Minimum of three (3) years of clinical practice experience is required
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
Current, unrestricted license to practice psychology in state of practice as necessary to meet regulatory requirements is required
MCG Certification is required or must be obtained within six (6) months of hire

Nice To Haves

Managed care medical review/medical director experience is preferred
Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred
Leadership experience and skills

Responsibilities

Assume responsibility for the overall safety of patients with a BH diagnosis
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)
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 Behavioral Health 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 related instructions, as requested