Medical Director-Behavioral Health|
Compensation: $225K - $265K / Year
Minimum Education: Doctorate
Job Type: Full Time
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Medical Director-Behavioral Health
Arthur L Crume
*Child Psychiatry or Adolescent Psychiatry -Board certification by the American Board of Psychiatry and Neurology.
*Current state medical license without restrictions - can be in the process of obtaining. Must have by time of background check.
*5+ years of experience working in behavioral health managed care or behavioral health clinical settings, with at least 2 years in a clinical setting.
Salary: $225K-$265K + 20% Bonus
Nationwide Relocation Assistance Available
Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.
Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
Supports effective implementation of performance improvement initiatives for capitated providers.
Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors.
Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
Participates in provider network development and new market expansion as appropriate.
Assists in the development and implementation of physician education with respect to clinical issues and policies.
Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
Interfaces with physicians and other providers in order 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 in order to determine medical necessity and appropriate payment.
Develops alliances with the provider community through the development and implementation of the medical management programs.
As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees.
Provide Psychiatric medical support for Health Plan.
Focused on areas related to psychiatric expertise, medical necessity review and providing support to clinical staff (UM and case management).
Duties will also include:
Medical necessity determination for inpatient and outpatient.
Clinical case discussions with clinical staff to provide clinical guidance which could involve outreach to providers.
*Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).
*The candidate must be an actively practicing physician.
*Previous experience within a managed care organization is preferred. *Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred.
*Experience treating or managing care for a culturally diverse population preferred.
*Board Certification through American Board Medical Specialties.
*Current state medical license without restrictions.
*Board certification by the American Board of Psychiatry and Neurology. *Current state medical license without restrictions.
Managed Care experience is preferred.
Previous experience working in Academics or other institutional role.
Certification in addiction medicine or in the sub-specialty of addiction psychiatry.
Equal opportunity employer that is committed to diversity, and values the ways in which we are different.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
ALC Staffing Associates
509 N Vermilion
Danville, IL 61832