Who we are:
Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.
Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.
A Day in the Life of a Medical Director of Behavioral Health:
Ultimately Responsible for clinical oversight of Meridian Health Plan's Behavioral Health and Substance Abuse Program. The Medical Director will oversee utilization review process, provide clinical supervision to Peer Advisors and Clinical Care Managers, identify areas for quality improvement, develop/implement policies and procedures with coordination of the Corporate Directors of Utilization Management and Quality Improvement, and our Medical Director. The Medical Director will also provide input into project and policies, procedures, protocols, criteria and guidelines through the clinical policy committee.
- Participate in development of Behavioral Health and Substance Abuse integrated care
- Consults with care managers and care manager supervisors to evaluate appropriateness and level of care for complex or difficult cases.
- Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers when applicable.
- Evaluates provider/facilities and providers data for provider profiling.
- Serves on Credentialing Committee
- Reviews requests for services that cannot be approved by clinical staff.
- Renders denial decisions for behavioral health and substance abuse services when indicated. Documents actions in MHP's Managed Care System.
- Participates in the staff development and in-service education programs for professional staff.
- Serves on committees as assigned.
What you can bring to Meridian:
- Professional experience of 3 years; experience in community field work desirable.
- Two years inpatient or hospital based treatment experience.
- Three to five years of clinical experience in behavioral health managed care.
- Three to five years of combined medical and behavioral health experience is preferred.
- Minimum of three years' experience in the application of clinical criteria such as internally developed or InterQual criteria.
- Unrestricted license M.D. or D.O. Degree in the designated State is required; Board Eligible or Board Certified Psychiatrist.
- Must have and maintain a current Physician License and Controlled Substance License from the designated State.
- Knowledge of managed care, particularly utilization management processes.
- Substantial knowledge of mental health and chemical dependency services and practices, including a broad band of treatment techniques and procedures and discharge planning.
- Knowledge of Medicaid and Medicare guidelines, medical necessity and benefit structure.
- Knowledge of managed care, utilization management, case management, and disease management
- Knowledge of National Committee for Quality Assurance (NCQA), URAC or general accreditation requirements and guidelines for utilization management, denials and appeals
- Knowledge and/or experience in the use of Patient Centered Medical Home for behavioral and medical conditions.