Behavioral Health Medical Director
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locations
Remote
time @type
Full time
posted on
Posted Today
job requisition id
R12930
Job Summary:
The Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing.
Essential Functions:
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
Contribute to the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
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
Provide cross-coverage for other Medical Directors and/or markets, as needed
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
Engage in Market professional society activities to enhance CareSource's objectives
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
Perform any other job related duties as requested.
Education and Experience:
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
Competencies, Knowledge and Skills:
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
Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred
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
Licensure and Certification:
Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements required
Board Certification in Psychiatry required
Re-certification, as required by specialty board, must be maintained
MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Flexible hours, including possible evenings and/or weekends as needed.
Ability to travel as required by the needs of the department.
Compensation Range:
$195,200.00 - $341,600.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level.In addition to base compensation, you may qualify for a bonus tied to company and individual performance.We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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About Us
The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers.
We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day.
The challenge is, there is no one right way to be the difference and we're looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.
