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Medical Director, Behavioral Health

Company: CareSource
Location: Dayton
Posted on: February 24, 2021

Job Description:

The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions:

  • Assume responsibility for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing
  • Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
  • Participate in regulatory/accreditation reviews
  • Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
  • BH coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting
  • Oversight and quality improvement activities associated with case management activities
  • Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
  • Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
  • Represent CareSource as the primary clinical liaison to members, providers and State agencies
  • Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs--
  • Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
  • Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
  • Collaborate with market/product leaders to help define market strategy
  • Community collaborative participation
  • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
  • Provide cross-coverage for other Medical Directors and/or markets, as needed
  • Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
  • Perform any other job duties as requested Education and Experience:
    • Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
    • Successful completion of a residency training program in psychiatry is required
    • Minimum of three (3) years of clinical practice experience is required
    • Experience in safe prescribing is required
    • Managed care medical review/medical director experience is 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
      • 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
      • 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 is required
        • Board Certification in Psychiatry is required
        • Re-certification, as required by specialty board, must be maintained Working Conditions:
          • General office environment; may be required to sit or stand for extended periods of time
          • May be required to work evenings/weekends
          • May be required to travel in-state to fulfill duties of position This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment. Posted 30+ Days Ago Full time R314 About Us The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we're looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Keywords: CareSource, Dayton , Medical Director, Behavioral Health, Healthcare , Dayton, Ohio

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