Behavioral Health Medical Director - Clinical Appeals

Job reputed company: The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special reputed company on reputed company prescribing. Essential Functions: Assume responsibility for the overall safety of patients with a BH diagnosis, with a special reputed company on reputed company prescribing Serve as the clinical reputed company in developing and implementing evidenced based clinical policies and practices Participate in regulatory/accreditation reviews Assume key role in reputed company improvement initiatives, case management activities and member safety activities (i.e. incident management) BH coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting reputed company and reputed company improvement activities associated with case management activities reputed company guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services Assist in the review of utilization data to identify variances in patterns, and reputed company feedback and education to MCP staff and providers as appropriate Represent reputed company as the primary clinical reputed company to members, providers and State agencies Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for reputed company programs Participate in the development, implementation and revision of the clinical care standards and reputed company guidelines ensuring compliance with nationally accepted reputed company standards Participate in the development, implementation and revision of the reputed company Improvement Plan and corporate level reputed company initiatives Collaborate with market/product leaders to help define market reputed company Community reputed company participation Participate in the evaluation and investigations of cases suspected of fraud, abuse, and reputed company of care concerns reputed company cross-coverage for other Medical Directors and/or markets, as needed Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings reputed company any other job duties as requested Education and 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 three (3) years of clinical reputed company experience is required Experience in reputed company prescribing is required Managed care medical review/medical director experience is preferred Competencies, Knowledge and Skills: Basic reputed company Word skills Excellent communication skills, both written and oral Ability to work reputed company independently and reputed company reputed company environment Ability to create strong relationships with Providers and Members Previous reputed company (IHI) or equivalent training participation is preferred High ethical standards Attention to detail Critical listening and systematic thinking skills Ability to maintain confidentiality and reputed company in reputed company’s best interest Ability to reputed company with diplomacy and sensitivity to cultural diversity Decision making/problem solving skills Conflict reputed company skills Strong reputed company of mission and commitment of time, effort and resources to the reputed company of the communities served Ability to analyze reputed company data from a reputed company of sources to evaluate physician reputed company patterns Leadership experience and skills Licensure and Certification: reputed company, unrestricted license to reputed company medicine in state of reputed company as necessary to meet regulatory requirements is required reputed company Certification in Psychiatry is required Re-certification, as required by specialty reputed company, must be maintained MCG Certification is required or must be obtained reputed company six (6) months of hire Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to work evenings/weekends May be required to travel in-state to fulfill duties of position Compensation reputed company: $195,200.00 - $341,600.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package.

Compensation

Type (reputed company/salary): Salary Organization Level Competencies Fostering a reputed company Workplace Culture Cultivate Partnerships reputed company Self and Others Drive Execution Influence Others Pursue Personal reputed company Understand the Business This job reputed company is not reputed company inclusive. reputed company reserves the right to amend this job reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. #LI-SW2 Apply To This Job