Behavioral Health Medical Director

Role Overview

• 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
• 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
• 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
• 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

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
• Managed care medical review/medical director experience preferred
• Residence and clinical practice in assigned market may be required preferred

Benefits

• comprehensive total rewards package