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Medical Director(Behavioral Health)

Company: National Coalition of Healthcare Recruiters
Location: Austin
Posted on: March 14, 2018

Job Description:

(Physician/MD qualifications required) Medical Director - Immediate opportunity for a Medical Director - Behavioral Health in the Austin area of TX.Responsibilities of the Medical Director - Behavioral Health: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. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief 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 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 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 public both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committeesRequirements of the Medical Director - Behavioral Health:Medical Doctor or Doctor of Osteopathy, board certified; Candidate must be a Board Certified Psychiatrist.Board Certification through American Board Medical Specialties. Current state medical license without restrictions.The candidate must be an actively practicing physician.Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and-or Personnel Management is preferred.Experience treating or managing care for a culturally diverse population preferred. Benefits:Relocation Assistance Health, Dental, Vision, 401(k) retirement with company match and many other.Bonus Structure Job Added: 01/19/2018

Keywords: National Coalition of Healthcare Recruiters, Austin, Medical Director(Behavioral Health), Executive, Austin, Texas

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