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Behavioral Health Medical Director (Full Time)

Dublin, OH | Full Time
13 Days Ago

Job Description

This role is eligible for a $10,000 sign-on bonus for external candidates

Responsibilities:

Provide organizational leadership in the operational areas of care management, utilization review, appeals, quality improvement and related policy and practice initiatives related to Behavioral Health in collaboration with the Corporate Medical Director, Behavioral Health and the Vice President, Utilization Management Physician.

The following responsibilities are in regards to working with enrollees diagnosed with mental illness and substance abuse conditions and their providers:

  • Identifies and implements evidence-based practice guidelines throughout the provider network
  • Oversees the quality of clinical care for network and non-network providers
  • Engages the provider network in Continuous Quality Improvement through the diffusion of practice standards, and through an internal quality assurance program that measures network provider performance against standards of high quality, especially the performance standards embodied in the HEDIS program.
  • Reviews and resolves disputes related to the quality of care
  • Utilizes a high-performing medical management system that adheres to the terms of contracts and all relevant regulatory requirements. 
  • Utilizes evidence based standards in making coverage determinations

Accountabilities:

  • Ensures the provision of quality and clinically sound behavioral health care services to all enrollees by associates and providers.
  • Serves as medical advisor and manager for all behavioral health clinically related activities.
  • Assures that organizations medical policies and procedures adhere to contractual obligations.
  • Performs clinical case reviews in conjunction with Medical Excellence Department.
  • Maintains familiarity with federal, state and local regulations that may pertain to the medical and clinical operations.
  • Provides leadership in the development and implementation of medical policy as it relates to behavioral health management.
  • Maintains compliance with applicable regulatory guidelines, AmeriHealth Caritas clinical policies and procedures, and contractual obligations.
  • Manages day-to-day operations and monitors the integration and processing of members to optimize appropriate use of behavioral and physical health services. Participates with Quality Improvement and Medical Excellence in the identification and analysis of medical and behavioral health information in order to develop interventions to improve clinical effectiveness of medical management strategies.
  • Works closely with a multidisciplinary team to ensure behavioral health management and quality management programs are meeting contractual obligations.
  • Works with the leadership of the Quality Improvement and Medical Excellence departments to develop competent clinical staff.
  • Trains staff on behavioral health-related issues and provide consultation to staff as appropriate.
  • Assists IHC Managers in assessing members’ need for case management services.
  • Attends case management meetings and monthly rounds as scheduled.
  • Collaborates with the integrated case management team, during scheduled meetings and informally as needed.
  • Thoroughly documents all care coordination activity in the member medical record in the electronic medical management system.
  • Adheres to AmeriHealth Family of Companies (ACFC) policies and procedures and supports and carries out the ACFC mission and values.
  • Other duties as assigned.

Education/Experience:

  •  MD.
  • 3-5 years Clinical Practice experience.
  • Must be licensed to practice in the state of Ohio; additional state licensures may be required for future business 
  • Must be board-certified in his/her medical specialty.
  • Must be clear of any sanctions by the applicable state or Office of the Inspector General.
  • Must not be prohibited from participating in any Federally or State funded healthcare programs.
  • Physician licensed to practice medicine and board-certified in general psychiatry  with at least 3-5 years combined work experience in mental health and/or  substance abuse treatment is preferred.
  • A board certified child and adolescent psychiatrist may be substituted with a board certified psychiatrist in general psychiatry having at least five (5) years’ experience providing services to children and youth.

Company Overview

  • Website amerihealthcaritas.com
  • Headquarters PHILADELPHIA, PA
  • Size 3,000 - 7,500
  • Founded 1983
  • Type
  • CEO PAUL A TUFANO
  • Revenue $5B - $10B
  • Industry Healthcare
  • About amerihealth caritas health plan
  • At AmeriHealth Caritas, care is the heart of our work. That means that every day we put our members and their families first. We work to improve not only their health, but also the economic and social issues that can act as a barrier to proper care ' the social determinants of health that are estimated to account for 70 percent of avoidable mortality in the U.S. alone. Through our Next Generation Model of Care, we emphasize preventive care, health maintenance, and community outreach programs with a strong focus on ensuring members have access to food, housing, utilities, and other basic necess ... ities. Our mission To help people get care, stay well, and build healthy communities. We have special concern for those who are poor. Our vision Our goal is to develop strategic partnerships and build accessible, flexible health systems across the nation. Moving forward as health care evolves, we will continue to ensure the greatest level of care at maximum value for members, providers, and governments. Ensuring equal access to health care through health equity and health literacy More than 77 million adults have basic or below basic health literacy ' or the ability to understand the basic health services and instructions they receive. Even more can't access the care they need because of social and cultural disparities. Low health literacy costs the U.S. billions of dollars every year and impacts the quality of care millions of Americans receive. In the spirit of our mission, our whole-person model of care leverages Culturally and Linguistically Appropriate Services (CLAS) standards and strong community partnerships. Through community outreach, collaboration with providers and their staff, and 24/7 access to interpretation services, we help to ensure each of our members gets the appropriate, unique care and services they need and deserve. More

Skills for Behavioral Health Medical Director (Full Time)

The job skills required for Behavioral Health Medical Director (Full Time) include Mental Health, Leadership, Collaboration, Analysis, Coordination,and Quality Improvement etc. Having related job skills and expertise will give you an advantage when applying to be a Behavioral Health Medical Director (Full Time). That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Behavioral Health Medical Director (Full Time). Select any job title you are interested in and start to search job requirements.

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The following is the career advancement route for Behavioral Health Medical Director (Full Time) positions, which can be used as a reference in future career path planning. As a Behavioral Health Medical Director (Full Time), it can be promoted into senior positions as a Top Behavioral Health Executive that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Behavioral Health Medical Director (Full Time). You can explore the career advancement for a Behavioral Health Medical Director (Full Time) below and select your interested title to get hiring information.