Behavioral Health Medical Director - Psychiatrist

Westmont, IL

Post Date: 11/21/2017 Job ID: 24795 Category: Registered Nurse

Job Description:
  • Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
  • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement 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 Chief 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 including committee structure, processes, and membership.
  • 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

Qualifications:
  • Board certified preferable in Psychiatry .
  • The candidate must be an actively practicing physician.
  • Previous experience within a managed care organization is preferred.
  • Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred.
  • Experience treating or managing care for a culturally diverse population preferred.
  • Board Certification through American Board Medical Specialties.
  • Current state medical license without restrictions.

For more information, please contact A-Line Staffing Solutions at 877-782-3334.

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