- Assures psychiatric involvement in the development, approval, and review of all medical necessity review criteria policies, procedures, and protocols governing clinical care.
- Works closely with the medical directors of physical health HMO's to ensure coordination between physical health and behavioral health needs and services.
- Plays significant role as interface with the Counties and DHS
- Reviews complaints and grievances in accordance with Community Care procedures and ensures prompt response and action at all stages of the complaint and grievance process.
- Works with Provider Relations to enhance the working relationship between Community Care and the providers in its network.
- Reviews proposed service denials and supervises care managers in the utilization of appropriate medical necessity criteria and ensures appropriate care management integration and coordination.
- Implements quality management programs and continue education activities.
- Interfaces with the Physical Health MCO's through Medical Director to Medical Director meetings and sit on appropriate committees of the PH MCOs.
- Advises senior management, especially Regional Directors, on the development and review of programs, positions, and budgets having an impact on clinical services.
- Acts as a liaison for Community Care with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services.
- Supports provider satisfaction with the care management process.
- Supervises Regional and associate medical directors.
- Meets or exceeds NCQA, URAC or other regulatory standards.
- Provides oversight and direction to the Quality Management Programming designing and evaluating protocols.
- Review the medical aspects of cost and utilization reports generated by Medical Management Information System
- Acts as a physician reviewer for cases referred by care management staff.
- Ensures the quality of clinical care provided to Community Care members.
- Participates in the appropriate committees of physical health HMO's where applicable, such as a pharmacy and therapeutics committee.
- Assures effective and appropriate utilization of the various levels of care in the provider network.
- Ensures the quality of treatment and related services provided by Community Care professional staff, through participation (directly or by designee) in the ongoing quality management and audit processes.
- Ensures prompt and fair resolution of care management decision appeals
- Interfaces with physician consultants and provide direction for the physician consultants.
- Supports member satisfaction with the care management process.
- Develops and maintains effective relationships with providers
- Minimum 10 years clinical experience.
- Doctor of Medicine or Doctor of Osteopathy from an accredited school.
- Unrestricted License in Pennsylvania.
- Post residency clinical experience.
- Experience in Behavioral Health treatment and program development.
- Board certified in addition medicine or board certified in addiction psychiatry preferred.
- At least 5 years of management experience preferred.
- Experience in managed care setting preferred.
- Ability to implement medical policies, and to enforce those policies through appropriate action.
- Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care.
- Ability to implement programs of quality care analysis, peer review, and professional education.
- Board Certification in Psychiatry required
- Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)
- Act 33 with renewal
- Act 34 with renewal
- Act 73 FBI Clearance with renewal
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Psychiatrist Senior Medical Director - Moosic, United States - UPMC
Description
We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community Care As Senior Medical Director, you will assure the quality and efficiency of the behavioral health care delivered to Community Care members.
Incorporated in 1996, Community Care was created by a leadership team whose clinical experiences as behavioral health providers compelled them to create a company whose mission is to improve the health and well-being of the community through the delivery of effective, cost-efficient, and accessible behavioral health services.
We are looking for a Psychiatrist to lead our mission of empowering individuals with behavioral health problems to live meaningful lives in the communities of their choosing.
If this sounds like an opportunity that meets your interests, we invite you to learn more and apply today
The Senior Medical Director provides guidance for clinical operational aspects of the program, including oversight of clinical decision-making, the use of appropriate qualified clinical staff, and periodic consultation with practitioners in the field.
This includes significant responsibility for quality management and utilization management and for assuring the adequacy of the provider network for the clinical needs of Community Care members.
The Senior Medical Director also participates in regional and company leadership policy decisions and strategic planning. In addition, the Senior Medical Director is a resource to participating providers in the provision of quality medical care.The selected candidate can be based anywhere within Pennsylvania.
Responsibilities:
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
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