Enterprise Medical Director-Behavioral Health(Must live in Mississippi)

Job Summary :

Ent Medical Director, Behavioral Health is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing.

Essential Functions :

• Support Mississippi Behavioral Health Market team program design and development and strengthening community collaboration
• Supervise part time Behavioral Health Medical Directors
• Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
• Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
• Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
• Provide provider education, training, data sharing, performance evaluations and orientation to the plan
• Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
• Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
• Collaborate with market / product leaders to help define market strategy
• Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
• Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
• Provide cross-coverage for other Medical Directors and / or markets, as needed
• Provide prior authorization medical reviews, consultation, and clinical review services
• Conduct clinical reviews for designated CareSource members
• Identify utilization management trends and take appropriate action
• Support market provider network development and maintenance
• Clinical Appeals
• Participate in peer-to-peer discussions
• Support staff by providing training, clinical consultation, and clinical case review for members
• Perform any other job duties as requested

Education and Experience :

• Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
• Successful completion of a residency training program, in psychiatry is required
• Minimum of five (5) years of clinical practice experience
• Clinical SUD / MAT experience is preferred
• Managed care medical review / medical director experience is preferred
• Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is 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
• 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 is required
• Board Certification in psychiatry is required
• Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)
• 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
• May be required to work evenings / weekends
• May be required to travel to fulfill duties of position
12 days ago