Behavioral Health Medical Director

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of ensuring the overall safety of patients with a Behavioral Health (BH) diagnosis, particularly emphasizing safe prescribing practices.

• Act as the clinical leader in the creation and implementation of evidence-based clinical policies and procedures.

• Engage in regulatory and accreditation reviews.

• Play a pivotal role in quality improvement initiatives, case management activities, and member safety operations.

• Make BH coverage determinations for utilization management to guarantee that members receive appropriate and medically necessary care in the most cost-effective manner.

• Oversee quality improvement initiatives related to case management activities.

• Offer guidance on BH orientation and network development/recruitment in collaboration with provider relations.

• Assist in analyzing utilization data to identify discrepancies in patterns and provide feedback and education to MCP staff and providers as necessary.

• Serve as the primary clinical liaison for CareSource to members, providers, and state agencies.

• Support regulatory and accreditation functions, ensuring compliance across all programs.

• Contribute to the development, implementation, and revision of clinical care standards and practice guidelines, ensuring adherence to nationally recognized quality standards.

• Participate in the formulation, execution, and revision of the Quality Improvement Plan and corporate-level quality initiatives.

• Collaborate with market and product leaders to help shape market strategy.

• Engage in community collaborative efforts.

• Take part in the evaluation and investigation of cases suspected of fraud, abuse, and quality of care issues.

• Provide cross-coverage for other Medical Directors and/or markets as required.

• Support staff by offering training, clinical consultation, and clinical case reviews for members, including participation in Medical Advisement meetings.

• Execute any other job responsibilities as assigned.

⛳️ Requirements

• A completed accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic Medicine (DO) is mandatory.

• Successful completion of a residency training program in psychiatry is essential.

• A minimum of three (3) years of clinical practice experience is required.

• Experience in safe prescribing is necessary.

• Managed care medical review or medical director experience is preferred.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Bonuses

• Substantial and comprehensive total rewards package