Psychiatrist

About the role

The Community Care Services (CCS) Psychiatrist (“Psychiatrist”) ensures access to direct clinical support and services to members upon assignment and for ongoing care, particularly for members at a Level 4 or 5 in severity. The Psychiatrist provides clinical direction to the CCS staff, conducts concurrent reviews, creates individual care plans, and implements treatment for members. They also assist the CCS Medical Director and CCS Executive Director in establishing new or revised policies and procedures.

Responsibilities

• Works under the programmatic supervision of the CCS Medical Director and the broad strategic oversight of the CCS Executive Director.
• Provides medical leadership in utilization management, cost-of-care, and medical quality improvement, prioritizing high cost and/or high utilizing CCS members.
• Performs medical review activities pertaining to health services utilization, quality improvement, and complex, controversial, or experimental medical services.
• Ensures timely and quality decision making, fulfilling compliance requirements and the timely needs of CCS members.
• Supports effective implementation of performance improvement initiatives for capitated providers.
• Assists the CCS Medical Director in planning and establishing goals and policies to improve quality and cost effectiveness of care and service for members.
• Manages the utilization of health care resources in accordance with CCS' objectives.
• Monitors relevant clinical aspects of a member's behavioral health, assisting the CCS Medical Director and CCS Executive Director in establishing new or revised policy and procedures.
• Edits and evaluates adverse trends in utilization of medical services and unusual provider practice patterns.
• Provides feedback to the CCS Medical Director and CCS Director, Behavioral Health regarding the adequacy of benefit/payment components in retaining and growing the BH provider network.
• Interfaces with physicians and other providers to facilitate implementation of recommendations to providers that would improve utilization and health care quality.
• Reviews claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment.
• Aids the CCS Medical Director or CCS Executive Director in developing strategic alliances with the provider community through the development and implementation of the medical/BH management programs.
• Ensures access to direct clinical support, treatment, and services to members upon assignment and for ongoing care. These services should be rendered either in office settings or in the community depending on member needs.
• Participates in member Individualized Treatment Plan (ITP) meetings when appropriate.
• Completes Assisted Community Treatment petitions and involuntary representative payee certifications when clinically indicated.
• Represents CCS before various publics both locally and nationally on medical philosophy, policies, and related issues, as assigned.
• Represents AlohaCare’s CCS at appropriate state committees and other ad hoc committees.
• May be required to work weekends and holidays in support of business operations.
• Adheres to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality.

Requirements

• Doctor of Medicine or Doctor of Osteopathy
• Current unrestricted Psychiatrist License in State of Hawaii
• Active Board Certification in the area of Psychiatry
• Minimum of 5 years of experience in psychiatric clinical practice
• Minimum of 3 years of experience or familiarity with individual care plan administration and care
• Experience in medical leadership of clinical services, programs, or provider organizations
• Achieves results, builds trust, communicates effectively, customer and quality focused
• Excellent interpersonal skills with the ability to communicate with all levels of the organization
• Strong interpersonal, facilitation and leadership skills with ability to interact with various departments/project teams
• Excellent, effective, and precise written and oral communication skills; speaks clearly and persuasively in positive or negative situations
• Able to organize, coordinate and supervise large projects in a timely, creative and effective manner
• Able to solve problems, analyze, think critically, make good judgments and make fair decisions
• Experience in project management, management reporting and analysis and excellent in building, maintaining and working with spreadsheets
• Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated
• Uses time effectively, reacts professionally under pressure
• Excellent leadership, communication, and analytical skills
• Strong customer service skills and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills
• Intermediate skills in Microsoft Programs: Word, Excel or Access
• Databases, Outlook and PowerPoint
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system
• Possession of a current valid Hawaii driver’s license and access to an insured automobile
• TB Clearance
• CPR Certification

Preferred Requirements

• Minimum of 3 years of experience in managed behavioral healthcare industry
• Medicare and Medicaid experience
• Demonstrated expertise and experience in Behavioral Health Services, including diagnosis of patients, assessment, treatment plans, and patient monitoring
• Experience in utilization management, case management and community services is desired
• Medicare and Medicaid experience

Physical and Environmental Demands

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• Work evenings and weekends as needed as the need for services arises.
• May require prolonged sitting-up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.