Behavioral Health Medical Director

Role Overview

• 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
• 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
• 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 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

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
• Managed care medical review/medical director experience is preferred

Benefits

• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements
• Bonuses
• Substantial and comprehensive total rewards package