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    Director, Medical Director - Philadelphia, PA, United States - Community Behavioral Health.

    Community Behavioral Health.
    Community Behavioral Health. Philadelphia, PA, United States

    2 weeks ago

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    Description

    Job Description The Medical Director of Adult Services is responsible for providing administrative oversight and supervision of the CBH physician advisors conducting utilization review for our adult members.

    The position provides leadership in the development and implementation of clinical/medical policies and initiatives as well as engagement of cross-systems stakeholders for adult services.

    The Medical Director may also conduct utilization reviews and will participate in the physician's after-hours call coverage.

    The Medical Director of Adult Services must be committed to fostering a supportive and collaborative environment, encouraging teamwork and mentorship at every level.

    He/she must support the mission, vision, and values of CBH and DBHIDS.

    Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission, vision, and corporate code of conduct.

    Serve as a role model by exemplifying the highest standards of professional behavior, language, skills, and experience in order to promptly, accurately, and compassionately serve the needs of stakeholders, members and their families.

    Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner.

    Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting individuality, cultural differences, dignity, and rights.

    Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
    Actively participate in required meetings and complete all mandatory training.

    Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste or abuse.

    Champion member safety and well-being as the top priority in day-to-day operations.

    Builds and maintains a strong functional team through effective recruiting, training, performance management, coaching, team building and succession planning.

    Provides supervision, guidance and leadership of adult physician advisors regarding clinical review of cases for medical necessity and care management
    Establishes and monitors performance expectations for adult physician advisors
    Ensures physician review processes and content are aligned with best practice standards (NCQA) and state regulatory requirements
    Coordinates physician schedules to ensure adequate coverage (including nights/weekends/holidays) of clinical services
    Partners with leadership team to ensure optimal care management and medical review functioning leading to improved outcomes for CBH members
    Provides medical leadership related to overall quality of care, medical decision making, case formulations, appropriate use of medication and other treatment modalities while addressing safety concerns specific to case review and levels of care
    Engages, collaborates and troubleshoots with providers and system stakeholders on clinical and administrative matters, including member placement, coordination of care, quality concerns and other challenges
    Participates in quality reviews as needed for specific member complaints, grievances, and agency reviews
    Participates in clinical and administrative meetings as required

    Participates in training and education with both internal and external stakeholders, including care managers, providers and others as required.

    Maintains expertise/education/training regarding most up-to-date standards of care
    Possesses leadership and medical experience necessary to effectively take on the tasks inherent in this role.

    Medical degree
    Board Certification in Adult Psychiatry

    Relevant Work Experience:
    Minimum of 3 years of experience in clinical psychiatry, preferably including inpatient exposure
    Proficient in Microsoft Word and Excel
    Strong administrative and managerial skills

    Leadership :
    Effectively manage and guide efforts to address challenges and drive continuous improvement for CBH's programs, services and processes. Recognize and promote the necessity to hire, assess, develop and retain high quality talent.

    Acknowledge strengths and weaknesses in team members through an ongoing performance management process that provides timely feedback in order to aid employee development and enhance team performance.

    Work Conditions (including travel, overtime required, physical requirements and occupational exposure):
    Must be able to travel within the City of Philadelphia.
    Ability to utilize computers and office equipment to complete daily work responsibilities.
    No protective equipment routinely needed.
    We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

    This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

    CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed.

    If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.

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