Job Summary:The Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing.
Essential Functions:- Assume responsibility for the overall safety of patients with a behavioral health (BH) diagnosis, focusing on safe prescribing practices
- Serve as the psychiatric lead in developing and implementing evidenced based clinical BH policies and practices for the state
- Conduct regulatory and accreditation reviews to ensure compliance with applicable standards
- Oversee BH coverage determination for utilization management, ensuring members receive appropriate and medically necessary care in the most cost-effective setting
- Lead quality improvement initiatives, case management activities and member safety protocols, including incident management
- Review utilization data to identify variances in patterns and provide feedback and education to Managed Care Plan (MCP) staff and providers as needed
- Represent CareSource as the primary psychiatric liaison to members, providers and state agencies
- Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
- Contribute to the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
- Collaborate with market and product leaders to define market strategy and enhance the quality and affordability of BH services
- Participate in community collaborative initiatives to improve BH services
- Evaluate and investigate cases suspected of fraud, abuse, and quality of care concerns
- Provide cross-coverage for other Medical Directors and/or markets, as needed
- Support staff through training, clinical consultation, and clinical case review for members, including Medical Advisement meetings
- Advocate for behavioral health in collaboration with the Market's government affairs and regulatory leads to advance CareSource's mission and meet specific advocacy goals
- Strengthen and develop relationships with specialty (CBHC) and IMD (standalone hospital) providers as needed in the Market
- Engage in Market professional society activities to enhance CareSource's objectives
- Consult with Market and Enterprise leadership to improve quality for members through collaborative execution of behavioral health quality improvement activities, including HEDIS and value-based reimbursement contracting
- Act as liaison with state agencies and organizations on BH initiatives, residing in the state market if required
- Perform any other job related duties as requested.
Education and Experience:- Medical Doctor (MD) required or
- Doctor of Osteopathic Medicine (DO) required
- Successful completion of a residency training program in psychiatry required
- Five (5) years of clinical practice experience required
- Experience in safe prescribing required
- Managed care medical review/medical director experience preferred
- Residence and clinical practice in assigned market may be required 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 required
- Board Certification in Psychiatry 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
- Flexible hours, including possible evenings and/or weekends as needed.
- Ability to travel as required by the needs of the department.
Compensation Range:
$195,200.00 - $341,600.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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