Enterprise Medical Director - Behavioral Health
About The Position
Enterprise Medical Director, Behavioral Health is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions: Support Ohio Behavioral Health Market team program design and development and strengthening community collaboration Supervise part time Behavioral Health Medical Directors Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management) Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs Provide provider education, training, data sharing, performance evaluations and orientation to the plan 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 Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate 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 Provide prior authorization medical reviews, consultation, and clinical review services Conduct clinical reviews for designated CareSource members Identify utilization management trends and take appropriate action Support market provider network development and maintenance Clinical Appeals Participate in peer-to-peer discussions Support staff by providing training, clinical consultation, and clinical case review for members Perform any other job duties as requested
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 five (5) years of clinical practice experience
- 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
- 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 (exceptions may be granted by Chief Medical Officer)
- MCG Certification is required or must be obtained within six (6) months of hire
Nice To Haves
- Clinical SUD/MAT experience is preferred
- Managed care medical review/medical director experience is preferred
- Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred
Responsibilities
- Support Ohio Behavioral Health Market team program design and development and strengthening community collaboration
- Supervise part time Behavioral Health Medical Directors
- Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
- Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
- Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
- Provide provider education, training, data sharing, performance evaluations and orientation to the plan
- 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
- Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
- 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
- Provide prior authorization medical reviews, consultation, and clinical review services
- Conduct clinical reviews for designated CareSource members
- Identify utilization management trends and take appropriate action
- Support market provider network development and maintenance
- Clinical Appeals
- Participate in peer-to-peer discussions
- Support staff by providing training, clinical consultation, and clinical case review for members
- Perform any other job duties as requested
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
Ph.D. or professional degree
Number of Employees
11-50 employees
