Behavioral Health Medical Director - Wheeling - The Health Plan of West Virginia Inc

    The Health Plan of West Virginia Inc
    The Health Plan of West Virginia Inc Wheeling

    1 week ago

    Default job background
    Full time
    Description

    Job Description

    The Behavioral Health Medical Director position at The Health Plan involves providing clinical guidance to the Behavioral Health Care Coordination and Utilization Management teams.

    Main Responsibilities:

    1. Facilitating integrated BH rounds, making clinical coverage determinations, maintaining clinical integrity, ensuring compliance with evidence-based guidelines.
    2. Collaborating with various clinical professionals and leadership teams, focusing on recovery-oriented and cost-effective care.

    Requirements:

    • MD/DO with board certification in Psychiatry, qualifications in Addiction Psychiatry or Medicine.
    • West Virginia and Ohio Physician License required, or willingness to obtain them within 90 days.
    • A minimum of three years of clinical experience beyond residency/fellowship is necessary, with supervisory and teaching experience preferred.

    Preferred Skills:

    • Basic computer literacy.
    • Prior leadership roles while in clinical practice is desirable.
    • Demonstrated ability to work in unison with other professionals and non-professionals in a respectful and harmonious manner.

    Salary Range:

    $120,000 - $180,000 per year, depending on experience.

    Key Responsibilities:

    1. Provide Physician oversight for activities related to the company's Behavioral Health Utilization Management, Care and Disease Management and Quality Management programs ensuring compliance with NCQA, Medicare, Medicaid, and other regulatory entities.
    2. Establish best behavioral health practices for care provided to members through participation in the development of clinical practice guidelines and selection of proprietary criteria and clinical pathways.
    3. Provide physician education regarding The Health Plan BH utilization management and quality management protocols and initiatives.
    4. Carry out specific functions as outlined in the BH Utilization Management Program including reviewing clinical BH utilization, delivering care to members, and maintaining daily interaction with hospital review staff.

    Estimated Salary:

    $150,000 per year.

    This role requires a strong understanding of healthcare regulations, excellent communication skills, and the ability to work collaboratively with various stakeholders. If you are a motivated and experienced medical professional looking for a challenging opportunity, please apply.

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