Plan Performance Medical Director- Psychiatrist- Louisiana Market

Elevance Health • Metairie, LA

7d • Hybrid

About The Position

Plan Performance Medical Director- Psychiatrist- Louisiana Market Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Candidates must live in Louisiana. The Plan Performance Medical Director is responsible for serving as the lead behavioral health clinician for the Louisiana market. Responsible for the administration of BH medical services for company health plan including the overall BH medical policies or clinical guidelines of the plan to ensure the appropriate and most cost-effective medical care is received. Drives direction of the account/market related to BH cost of care and other plan directives. Meets regularly with account/market BH Director to address and improve UM and CM operations. How you will make an impact: Provides liaison from account/market to State, Health plan Leadership, CST, BH Leadership, Manager Medical Director, COC work groups, client partnerships and others as needed to support BH in the specific market. Serves as resource/SME regarding local contractual and/or regulatory requirements related to UM/CM and market/account-specific strategy. Provides consultation to the plan, as needed, regarding quality concerns and state fair hearings. Coordinates with PH counterparts to improve the delivery of whole person care. Supports the BH Medical Management staff 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. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. Interprets existing policies or clinical guidelines and develops new policies based on changes in the healthcare or medical arena. Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care. Identifies and develops opportunities for innovation to increase effectiveness and quality. Provides expertise, captures and shares best practices across regions to other medical directors. May chair or serve on health plan or company committees, as allowed under the delegation agreement; may be required to represent the company to external entities and/or serve on external committees.

Requirements

• Requires MD or 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 in Louisiana.
• 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.
• Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• For Health Solutions and Carelon organizations (including behavioral health) only, minimum of 5 years of experience providing health care is required.
• Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.

Nice To Haves

• Addiction or Child and Adolescent board certifications preferred.

Responsibilities

• Provides liaison from account/market to State, Health plan Leadership, CST, BH Leadership, Manager Medical Director, COC work groups, client partnerships and others as needed to support BH in the specific market.
• Serves as resource/SME regarding local contractual and/or regulatory requirements related to UM/CM and market/account-specific strategy.
• Provides consultation to the plan, as needed, regarding quality concerns and state fair hearings.
• Coordinates with PH counterparts to improve the delivery of whole person care.
• Supports the BH Medical Management staff 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.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
• Interprets existing policies or clinical guidelines and develops new policies based on changes in the healthcare or medical arena.
• Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care.
• Identifies and develops opportunities for innovation to increase effectiveness and quality.
• Provides expertise, captures and shares best practices across regions to other medical directors.
• May chair or serve on health plan or company committees, as allowed under the delegation agreement; may be required to represent the company to external entities and/or serve on external committees.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

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