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Behavioral Health Medical Director
Location
Louisiana
Posted
85 days ago
Salary
$225.7K - $428.9K / year
Seniority
Lead
Job Description
Behavioral Health Medical Director
Centene Corporation Group
• Assist the Sr Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. • Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. • Supports effective implementation of performance improvement initiatives for capitated providers. • Assists Sr Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. • Assists the Sr Medical Director in the functioning of the physician committees including committee structure, processes, and membership. • Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. • Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex 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 practice patterns, and adequacy of benefit/payment components. • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality 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 quality. • Reviews claims involving complex, 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. • As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. • Represents the business unit at appropriate state committees and other ad hoc committees. • May be required to work weekends and holidays in support of business operations, as needed. • Performs other duties as assigned. • Complies with all policies and standards
Job Requirements
- Must be licensed in Louisiana
- Board certification by the American Board of Psychiatry and Neurology
- 5+ years of post-residency experience
- Medical Doctor or Doctor of Osteopathy
- Utilization Management experience and knowledge of quality accreditation standards preferred
- Actively practices medicine.
- Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous
- Experience treating or managing care for a culturally diverse population preferred
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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