- Board-certified psychiatrist for Behavioral Health Medical Director
- 100% Administrative role
- Medicaid agency employed
- Utilization Management, leadership, and/or managed care experience very desirable
- Hybrid position; requires 1 day per week on-site and a few days per month physically present in other locations (state office, etc) as needed
- Minimum of 10 years of clinical experience; or combination of education and experience
- The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received.
- Responsible for developing and implementing programs to improve quality, cost, and outcomes.
- This role will provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations.
- Supports clinicians to ensure timely and consistent responses to members and providers.
- Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patient office visits with providers and external physicians.
- May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
- May be required to represent the company to external entities and/or serve on internal and/or external committees.
- May chair company committees and be responsible for an entire clinical program.
- Interprets medical policies and clinical guidelines. May develop and propose new medical policies based on changes in healthcare.
- Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
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