Behavioral Health Medical Director
Compensation: $101,000.00 - $72,960.00 /year *
Employment Type: Full-Time
Industry: Healthcare - Allied Health
Job Title: Remote National Behavioral Health Medical Director Managed Care
Category Temporary: Physicians
City: Lock Haven
Remote National Behavioral Health Medical Director Will cover 6 states 180k total Medicare and Medicaid members Must have experience managing Medical Directors in multiple states at one time Must have solid Utilization Review experience The National Director of Utilization Management, Behavioral Health will oversee utilization management, case management, care coordination, and peer-support programs providing clinical leadership to behavioral health teams across the country. Additionally, the Director of UM - BH will strategically support the design, implementation, and oversight of integrated behavioral health care management. Requirements for National Director of Utilization Management - Behavioral Health: M.D. or D.O. board certified in psychiatry. 5+ years post residency, clinical psychiatric experience Experienced in behavioral utilization review with a health plan Experience managing a clinical behavioral health UM review team, including physicians Unrestricted medical license
Strong understanding of the behavioral health managed care landscape The ability to travel, supporting regional and local BH teams The National Director of Utilization Management - Behavioral Health will: Serves as physician advisor for utilization management, cost containment, and quality improvement activities. Perform BH medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services including LTSS initial reviews and appeal reviews of denial determinations made by other reviewers. Assists in the planning and establishing of goals and policies to improve quality and cost-effectiveness for plan membership. Participates in the development of state and corporate long-term services and supports clinical standards, best practice guidelines and clinical policy to improve member care. Provides behavioral health expertise in the operation of approved quality improvement and utilization management
programs in accordance with regulatory, state, corporate, and accreditation requirements. Monitors all utilization management program activities for quality compliance according to NCQA and CMS standards. Participates in physician committees including committee structure, processes, and membership. As the behavioral health leader, represents the health plan at appropriate state and other ad hoc committees. Participates in provider network development and new market expansion, including RFP responses, as appropriate. Assists in the development and implementation of behavioral health physician education regarding clinical issues and policies. Works directly with physicians and providers to implement recommendations to improve utilization and health care quality. Partners with the provider community to develop and implement BH management programs. Implement and follow clinical practice guidelines and medical necessity review criteria.
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* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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