Medical Director BH / MH

ALC Staffing Associates  •  Austin, TX

5 - 7 years experience  •  Healthcare

$276K - $300K ($230K - $250K base + 20%)
Posted on 06/09/18 by Arthur Crume
ALC Staffing Associates
Austin, TX
5 - 7 years experience
Healthcare
$276K - $300K
($230K - $250K base + 20%)
Posted on 06/09/18 Arthur Crume

Medical Director BH/MH

(Board Certified Child and Adolescent Psychiatrist)

*Board certification by the American Board of Child and Adolescent Psychiatry.

*Current state medical license without restrictions.

*5-10 years of experience working in behavioral health managed care or behavioral health clinical settings, with at least 2 years in a clinical setting.

Austin, TX

Salary: $230K-$250K + 20% Bonus

Nationwide Relocation Assistance Available

Position Purpose:

Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

Job Description:

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.

More on the role:

Main job duty is performing medical review activities for utilization review including but not limited to psychotropic medication reviews, quality assurance reviews and reviews on complex, controversial, or experimental BH/MH medical services with primary focus on children and adolescents, and secondary focus on young adults.

Medical Director will be expected to provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements and to assist in the development and implementation of Staff and Provider education with respect to clinical issues and policies. Medical Director will be expected to attend and actively participate in clinical and case management Rounds and other Rounds activities, as requested.

Medical Director may attend and actively participate in various committees and workgroups, as requested.

Medical Director will be expected to perform other duties, as assigned.

This position can be remote anywhere in Texas if not local to Dallas, Austin or San Antonio.

2-3 most important objectives for this position over the next year:

Learn systems, policies, and procedures germane to the Medical Director role Superior to reduce and eventually discontinue use of all external reviewers for BH/MH utilization review.

Assist with the transition, integration, and alignment of Behavioral Health (BH) operations with Physical Health (PH) operations as pertains to utilization review.

Qualifications:

*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.

*Board certification in general psychiatry or child psychiatry.

*5+ years of experience working in behavioral health managed care or behavioral health clinical settings, with at least 2 years in a clinical setting.

*Certification in addiction medicine or in the sub-specialty of addiction psychiatry preferred.

Nice-to-have:

PMUR experience (Psychotropic Medication Utilization Review) Certification in addiction medicine or in the sub-specialty of addiction psychiatry preferred.

Will need great people skills ?will be working with prescribers.

Someone who has worked with the underserved populations.

Clinical Pharmacy background would be a plus.

Will not be required to have managed care but is preferred Peer review experience? reviewing the work of other clinicians (primary care providers, clinicians, psychiatrists).

Good listening skills, empathy, good coaching skills.

Experience in an Academic or Hospital setting.

Experience working in Local Mental Health community centers ? federally qualified health centers (FQHCs).

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.

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