Behavioral Health Medical Director

US-Irvine, CA or Chicago, IL
Req No.
2017-2159
Category
Clinical/Medical
Type
Regular Full-Time

Overview

Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.
The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.
 
Summary:
Concerto Healthcare is looking for a Behavioral Health Medical Director to partner with the Utilization Management and care delivery teams.  The Behavioral Health Medical Director oversees daily utilization management and serves as subject matter expert and advisor for clinical program development. The Behavioral Health Medical Director will monitor all issues of clinical quality management as it related to Behavioral Health within in the confines of the quality oversight policies and procedures and will also advise the local care delivery teams in regards to their programs to optimize the outcomes for Concerto members.  The Behavioral Health Medical Director will collaborate with Regional Medical Directors and drive evidence-based practice and medical-behavioral integration.

Responsibilities

  • Responsible and accountable to the Corporate Senior Medical Director of Utilization Management for helping to manage health plan medical costs and assuring appropriate delivery of products and services related to behavioral health. Reports organizationally to the Senior Medical Director of Operations.
  • Supports design and implementation of medical policies, and appropriate BH UM goals and objectives.
  • Interfaces with provider community in regards to Behavioral Health Utilization Management and evidence based medicine
  • Provides professional leadership and direction to the functions within the Utilization Management Department
  • Responsible and accountable for executing the Behavioral Health Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs in partnership with the Utilization Management Department and Regional Medical Directors
  • Assists the Regional Medical Directors with activities to promote positive community relations, particularly with behavioral health providers and entities
  • Assures plan conformance with legal and regulatory requirements.
  • Collaborates with Regional Medical Directors in creating and maintaining programs that incentivize providers to achieve selected utilization and quality outcomes
  • Provides periodic written and verbal reports and updates regarding Utilization Management as required in the Quality Management Program description, the Annual Work Plan and Community Care policy and procedures to various plan committees, the health plan Market Medical Director.
  • Supports URAC, AHCA and NCQA qualification activities.
  • Monitors member and provider satisfaction survey results with the UM process and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
  • Participates in key marketing activities and presentations.
  • Promotes wellness and ensures programs of prevention, education and outreach to members and providers consistent with company’s mission, vision and values.
  • Contributes to and oversees in-service training and education of professional staff.
  • Represents at medical group meetings, conferences, etc. as appropriate and requested by Senior Medical Director and/or Regional Medical Directors
  • Participates in the development of strategic planning for existing and expanding business.
  • Recommends changes in program content in concurrence with changing markets and technologies.
  • Participates in key marketing activities and presentations, as necessary, to assist the marketing and branding efforts.
  • In partnership with Regional Medical Directors, create and execute educational curriculum to clinicians and support staff in regards to behavioral health and substance abuse topics
  • Participate in interdisciplinary care team meetings regarding high-complexity members with behavioral health or substance abuse-related diagnoses
  • Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.

Qualifications

Required:

  • Graduate of an accredited medical school with MD/DO is required. Advanced training in public health or other related fields of study is preferred.
  • Board certification in psychiatry is required.
  • 3-5 years of clinical practice and progressively responsible medical administrative experience preferred.

Preferred:

  • Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder.
  • Excellent interpersonal, verbal, and written communication skills.
  • Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.
  • Ability to navigate in a corporate matrix environment.


Knowledge and Skills:

  • Management skills to meet the organizational goal.
  • Must possess excellent communications skills to interface with providers, staff, and management.
  • Knowledge of medical, quality improvement and UM practices in a managed care environment.
  • Knowledge of regulatory and accreditation agencies and requirements.
  • Able to manage multiple priorities and deadlines in an expedient and decisive manner.
  • Able to manage difficult peer situations arising from medical care review.
  • Appreciation of cultural diversity and sensitivity towards target population.

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