MEDICAL DIRECTOR- INTEGRATED CARE – Psychiatrist
..........National health plan is growing and diversifying in the NEVADA. This is an exceptional leadership team.
A physician seeking a purposeful career with an opportunity to make a difference in the quality of care and access to care - particularly for mental health- will thrive in this role.
Collaborates with Senior Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for this market.
Provides medical leadership of all for UM, cost containment, and medical QI 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 Senior 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 and 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
-MD or DO
-Board certified in psychiatry.
-5+ years experience working in a behavioral health managed care setting or a behavioral health clinic settings.
-Appropriate training and expertise in general psychiatry and/or addiction disorder.
-Must be an actively practicing physician.
-Previous experience within a managed care organization is strongly preferred.
- Experience treating or managing care for a culturally diverse population preferred.
-Board certified by the American Board of Psychiatry and Neurology.
-Current state medical license without restrictions.
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Keywords: MD, DO, Washington