REMOTE - Behavioral Health Medical Director - 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.

About the Role

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
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
Perform any other job related duties as requested.

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
• 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
• 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
• 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

Licenses and Certifications

• Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements required
• Board Certification in Psychiatry required
• 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

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.