Physician Advisor (Psychiatrist)

About the Role

The Physician Advisor provides strategic oversight of medical necessity determinations for behavioral health services, ensuring alignment with clinical standards and organizational objectives. This role is accountable for conducting medical necessity and peer reviews, directing the activities of the crisis team, and fostering collaboration with clinical providers to promote high-quality, effective mental health care for CBH Members.

Responsibilities

• Review cases from multiple sites and levels of care for medical necessity.
• Perform peer reviews for disputed levels of care.
• Conduct medical reviews and make denial decisions based on medical necessity.
• Participate in clinical and administrative meetings.
• Interact with providers on clinical and administrative matters.
• Serve as a clinical leadership resource and consultant to Clinical Care Managers, offering guidance on complex cases and best practices.
• Perform key responsibilities in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
• Serve as a role model by exemplifying professional behavior, language, skills, and attire.
• Assure adherence to CBH policies and procedures to deliver high-quality, culturally competent, and cost-effective work.
• Promote and manage diversity and acceptance within CBH and among members and stakeholders.
• Offer suggestions and develop solutions to improve work processes and innovative programs.
• Actively participate in required meetings and complete all mandatory trainings.
• Maintain high levels of advocacy and member confidentiality.
• Assist in assuring program integrity by reporting suspected instances of fraud, waste, or abuse.

Requirements

• MD/DO from an accredited medical school.
• Current Board certification in Psychiatry and/or Child and Adolescent Psychiatry by the American Board of Psychiatry and Neurology.
• Current and active State of Pennsylvania Medical License.
• Minimum of 5 years of clinical psychiatry experience, including significant and specific experience with inpatient care and substance abuse treatment.

Skills

• Ability to provide clinical oversight on a wide array of operational activities.
• Strategic and financial planning.
• Excellent written and verbal communication skills.
• Familiarity with medical assistance regulations and managed care principles and practices.
• Knowledge of Managed Care Organization operations and principles.
• Demonstrated leadership ability.

Core Competencies

• Teamwork and Collaboration: Build and sustain relationships with co-workers and stakeholders, supporting efforts and deliverables.
• Respect: Treat others and members with respect and sensitivity, recognizing diversity.
• Member Centric: Focus on member needs by providing value-added services and promoting strong relationships.
• Honesty and Integrity: Maintain the highest level of integrity in all actions.
• Commitment to Service Excellence: Provide first-in-class service and high-quality, innovative programs.
• Compassion and Empathy: Demonstrate appreciation for others' situations and perspectives.
• Problem Solving: Build and implement logical solutions using individual knowledge and experience.
• Initiative and Self-Directed: Proactively manage time and resources efficiently.
• Flexibility and Adaptability: Adjust approaches to meet changing environments and goals.
• Communication: Effectively share and receive information, both written and oral.

Leadership Competencies

• Strategic Thinking: Integrate CBH’s long-term vision into current activities.
• Leadership: Guide efforts to address challenges and drive continuous improvement.
• Employee Development: Hire, assess, develop, and retain high-quality talent.

Additional Requirements

The successful candidate must be a current Philadelphia resident or become a resident within six months of hire. CBH does not provide sponsorship for applicants requiring future work authorization; candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.