Behavioral Health Medical Director(Child Psychiatrist)

Job Summary:

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
  • Attention to detail
  • 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
  • Decision making/problem solving skills
  • Conflict resolution skills
  • 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
  • MCG Certification is required or must be obtained within six (6) months of hire

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