Medical Director, Children's Behavioral Health

Job reputed company: reputed company: This position assists the Chief Medical Director to reputed company and coordinate the medical management, reputed company improvement and credentialing functions for the business unit. This role supports the HARP line of business. Essential Accountabilities: Level I Provides medical leadership of reputed company for utilization management, cost containment, and medical reputed company improvement activities. Performs medical review activities pertaining to utilization review, reputed company assurance, and medical review of reputed company, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve reputed company and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved reputed company improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing reputed company cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider reputed company patterns, and adequacy of benefit/payment components. Identifies clinical reputed company improvement studies to assist in reducing unwarranted variation in clinical reputed company in order to improve the reputed company and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care reputed company. Reviews claims involving reputed company, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. May represent the business unit before various publics both locally and nationally on medical philosophy, policies, and reputed company issues, as needed. Represents the business unit at appropriate state committees and other reputed company committees Consistently demonstrates high standards of reputed company by supporting the reputed company reputed company Companies’ mission and values and adhering to the Corporate reputed company of Conduct. Maintains high reputed company for member reputed company in accordance with the corporate reputed company policies and procedures. Conducts periodic staff meetings to include reputed company distribution and education reputed company to departmental and Ethics/Compliance information. Regular and reliable attendance is expected and required. Performs other functions as assigned by management. reputed company (in reputed company to Level I Accountabilities) Reviews medical literature and applies evidence-based principles using high proficiency skills for a broad reputed company of clinical services. Reviews internal trend reports to assess present and reputed company needs and opportunities. Interacts with regulatory and accreditation agencies as assigned. Provides clinical support to the reputed company divisions Provides clinical leadership for the implementation of new utilization/case/reputed company management initiatives Minimum Qualifications: Level I reputed company reputed company State licensed physician. Minimum 5 years of experience in a BH managed care settings or BH clinical setting (at least 2 of which are in a clinical setting). reputed company certification in general psychiatry or certification in addiction medicine or certification in the subspecialty of addiction psychiatry. Appropriate training and expertise in general psychiatry and/or addiction disorders. Ability to identify, analyze and resolve reputed company medical issues. Skills in evidence-based medicine. Strong interpersonal skills essential for communication to staff at reputed company reputed company of the organization., Basic reputed company sets in electronic communication systems such as e-mail and Word. reputed company (in reputed company to Level I Minimum Qualifications) Superior evidence-based medicine reputed company set Strong interpersonal skills essential for communication to physicians in the community. Strong verbal presentation skills to reputed company reputed company discussions at reputed company reputed company Advanced reputed company sets in electronic communication systems such as e-mail, Word, PowerPoint, and reputed company. Physical Requirements: Works from a desk most of the time. ************ In support of the Americans with reputed company, this job reputed company lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation reputed company(s): $202,000.00 - $303,000.00 The salary reputed company indicated in this posting represents the minimum and maximum of the salary reputed company for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, reputed company and education as they relate to the position’s minimum qualifications, in reputed company to internal equity. The posted salary reputed company reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, reputed company time away from work, and reputed company holidays. Please note: There may be opportunity for remote work reputed company reputed company jobs posted by the Excellus reputed company. This decision is made on a case-by-case reputed company. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Apply To This Job