We are the Health Care Management division of HCSC — a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.
We’re also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.
This position is a board certified psychiatrist responsible for medical necessity determinations with respect to behavioral health disorders at all levels of care which includes telephonic peer-to-peer (physician to physician) reviews and telephone reviews with facility UR personnel. Additional duties include: review of "cases" with Care Management professional staff (case consultation); review of medical records; participation in committees; representing the department with internal and external key stakeholders such as providers, regulatory bodies, members and customers; directing the inclusion of behavioral health expertise at all levels of the program and throughout the enterprise, as well as external to HCSC; accountability for establishing and meeting utilization goals; and other duties as assigned.
*Doctoral degree (MD or DO) with current, active, valid, unrestricted license.
*Board certified in psychiatry.
*5 years clinical experience in behavioral health care.
*Knowledge of state and federal health insurance regulations.
*Verbal and written communications skills to include delivering presentations to committees and acting as company representative to key stakeholders including providers, regulatory bodies, etc.
*PC experience to include Microsoft Office suite of applications (Word, Excel, and PowerPoint) and databases.
*Ability and willingness to travel, including overnight stays (approximately 15 overnight travel).
PREFERRED JOB REQUIREMENTS:
*1 year behavioral health experience in a managed care environment. Experience conducting medical necessity reviews and applying NCQA standards and URAC requirements.
*2 years management experience including hiring, performance review, and oversight of budget.
*Experience directing the work of other psychiatrists especially in the area of medical necessity determination.
*Project management experience including leading projects
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Job ID: AK-1032165