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
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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.
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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
#LI-SW2
Brand=CareSource
