Job Summary:
The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting.
Essential Functions:
-
Assume responsibility for the overall safety of patients with a BH diagnosis
-
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 (i.e. incident management)
-
Oversight and quality improvement activities associated with case management activities
-
Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
-
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 (e.g. CMS, State, NCQA and URAC) 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 Behavioral Health 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 related instructions, as requested
Education and Experience:
-
Completion of an accredited clinical psychology program is required
-
Successful completion of a doctoral internship program in psychology is required
-
Minimum of three (3) years of clinical practice experience is required
-
Managed care medical review/medical director experience is 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 psychology in state of practice as necessary to meet regulatory requirements is required
-
MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions:
-
General office environment; required to use general office equipment
-
May be required to work evenings/weekends
-
May be required to travel in-state to fulfill duties of position
Compensation Range:
$94,100.00 - $164,800.00
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
#LI-SW2
