Medical Director, Behavioral Health - Market

Company: PSECU
Location: Little Rock
Posted on: September 12, 2020

Job Description:

Title Medical Director, Behavioral Health - Market

City Arkansas

State AK

Description Role and Responsibility:

§ Development, implementation and revision of the market-level clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards

§ Collaborate with market/product leaders to help define market strategy

§ Represent CareSource at state and regulatory venues

§ Support market provider network development and maintenance

§ Provider education, training, data sharing, performance evaluations and orientation to the plan

§ Support program design and development

§ Participate in peer-to-peer discussions

§ Participate in the development, implementation and revision of the Quality Improvement Plan and market level quality initiatives

§ Community collaborative participation

§ Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns

§ Development of policies and procedures

§ Provide cross-coverage for other Medical Directors and/or markets, as needed

§ Understand and provide support to prior authorization and utilization review functions

§ Support staff by providing training, clinical consultation, and clinical case review for members

§ Conduct clinical reviews for designated CareSource members

§ Identify utilization management trends and take appropriate action

§ Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs

Perform any other job related instructions, as requested

Requirements Education / Experience:

§ Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required

§ Successful completion of a residency training program in psychiatry is required

§ Minimum of five (5) years of clinical practice experience is required

§ Managed care medical review/medical director experience is preferred

§ Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred

Required Competencies / Knowledge / 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

§ 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 / Certification:

§ Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required

§ Board Certification, preferably in primary care specialty is required

§ Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)

Accountability:

Working Conditions:

§ General office environment; required to use general office equipment

§ May be required to work evenings/weekends

May be required to travel to fulfill duties of position

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.

Keywords: PSECU, Little Rock , Medical Director, Behavioral Health - Market, Other , Little Rock, Arkansas