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Job Description :
Psychiatrist - Medical Director of Behavioral Health
These positions are responsible for ensuring that high quality, cost effective and appropriate mental health and substance use disorder health care is delivered by qualified plan providers to members, according to product or benefit design.
Medical Director Openings:
1 Part Time Psychiatrist (20 hrs/week)
1 Per Diem Psychiatrist (up to 20 hrs/month)
Both roles can be worked remotely and will offer a flexible schedule that can work around another job. The Part Time role is eligible for Medical and Dental Insurance, 401k with match and PTO.
- Ensures overall Behavioral Health program integrity through claim review and associated documentation to assure services are appropriate. Provides clinical expertise and judgment to effectively focus on areas of misuse as well as potential fraud and abuse.
- Oversees internal Behavioral Health review guidelines to ensure compliance with regulatory requirements. Advises on policies and procedures relating to the Behavioral Health program, including those needed to meet regulatory, accrediting and other oversight organizations.
- Acts as a resource for staff members and serves as Behavioral Health clinical lead to medical policy development process.
- Actively participates in the Quality Improvement Process and departmental quality initiatives through auditing responsibilities, departmental corrective action team projects, and the open sharing of thoughts and ideas for improving work processes related to Behavioral Health.
- Responsible for physician review and oversight of all potential adverse determinations (for all lines of business) including pre-certification/prior authorization, concurrent review and retrospective audits. Coordinates the responses needed to address regulatory and accreditation concerns pertaining to medical management issues.
- Participates on Corporate Medical Policy committee. Participates in the provider evaluation and education. Researches and evaluates current and new Behavioral Health policies in keeping with regional, corporate and association guidelines.
- Fosters positive relations within the regional medical and Behavioral Health community, interacting with hospitals, physicians, and other providers. Provides Behavioral Health leadership in the coordination of medical management linkages with participation and non-participating hospitals, facilities, vendors, MCO's, etc.
- Actively participates in leadership/management activities to help identify internal and external challenges and opportunities, contributes to sound organizational strategies and actions, and provides insight, feedback and counsel to other members of the management team.
- At the direction of the Senior Medical Director of CMO engages in external activities or initiatives which are important to HealthNow's community leadership role and may include oversite or participation in work groups, leadership forums, and not-for-profit board positions.
Required Qualifications :
- Must be licensed to practice medicine in New York State without restriction
- Board certification is required (psychiatric/chemical dependency) and a minimum of ten years of experience in a clinical setting.
- Experience in medical utilization review practices, medical and administrative policy and procedure development and medical management strongly preferred.
- Must possess superior interpersonal, presentation and communication, analytic and negotiating abilities.
- Knowledge of managed care principles including utilization review procedures, risk management, network management, and provider profiling is desirable.
- Strong leadership qualities and the ability to interface with personnel at all levels of the corporation as well as members of various medical societies and government representatives as required.
- The incumbent must keep abreast of medical practice and technology changes that may result in improper medical service requests, billing or program abuse. This is accomplished through continuing education opportunities and certification requirements.