Behavioral Health Medical Director at CareSource Management Services LLC — Remote

Job Summary:

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

Essential Functions:

• Assume responsibility for the overall safety of patients with a behavioral health (BH) diagnosis, focusing on safe prescribing practices
• Serve as the psychiatric lead in developing and implementing evidenced based clinical BH policies and practices for the state
• Conduct regulatory and accreditation reviews to ensure compliance with applicable standards
• Oversee BH coverage determination for utilization management, ensuring members receive appropriate and medically necessary care in the most cost-effective setting
• Lead quality improvement initiatives, case management activities and member safety protocols, including incident management
• Review utilization data to identify variances in patterns and provide feedback and education to Managed Care Plan (MCP) staff and providers as needed
• Represent CareSource as the primary psychiatric liaison to members, providers and state agencies
• Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
• Contribute to the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
• Collaborate with market and product leaders to define market strategy and enhance the quality and affordability of BH services
• Participate in community collaborative initiatives to improve BH services
• Evaluate and investigate cases suspected of fraud, abuse, and quality of care concerns
• Provide cross-coverage for other Medical Directors and/or markets, as needed
• Support staff through training, clinical consultation, and clinical case review for members, including Medical Advisement meetings
• Advocate for behavioral health in collaboration with the Market's government affairs and regulatory leads to advance CareSource's mission and meet specific advocacy goals
• Strengthen and develop relationships with specialty (CBHC) and IMD (standalone hospital) providers as needed in the Market
• Engage in Market professional society activities to enhance CareSource's objectives
• Consult with Market and Enterprise leadership to improve quality for members through collaborative execution of behavioral health quality improvement activities, including HEDIS and value-based reimbursement contracting
• Act as liaison with state agencies and organizations on BH initiatives, residing in the state market if required
• Perform any other job related duties as requested.

Education and Experience:

• Medical Doctor (MD) required or
• Doctor of Osteopathic Medicine (DO) required
• Successful completion of a residency training program in psychiatry required
• Five (5) years of clinical practice experience required
• Experience in safe prescribing required
• Managed care medical review/medical director experience preferred
• Residence and clinical practice in assigned market may be required 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
• Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred
• 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 required
• Board Certification in Psychiatry required
• Re-certification, as required by specialty board, must be maintained
• 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
• Flexible hours, including possible evenings and/or weekends as needed.
• Ability to travel as required by the needs of the department.

Compensation Range:

$195,200.00 - $341,600.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

#LI-SW2

Brand=CareSource