Excellus BCBS
Medical Director, Psychiatry (SafetyNet & Behavioral Health)
Excellus BCBS, Jamestown, New York, United States, 14704
Medical Director, Children's Services (SafetyNet & Behavioral Health)
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Medical Director, Children's Services (SafetyNet & Behavioral Health)
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Excellus BCBS This position provides clinical leadership for the development and implementation of the Children’s Behavioral Health (BH) Carve-In program, overseeing BH services for Medicaid Managed Care enrollees under age 21. Essential Responsibilities
Lead and develop the Children’s Behavioral Health Carve-In program following NYS guidelines. Perform medical necessity reviews, peer-to-peer calls, and support case management staff. Lead interdisciplinary care management rounds. Provide clinical oversight to Utilization Management/Case Management staff working with children. Develop and interpret clinical policies impacting children's health and wellbeing. Coordinate between BH and physical health care services. Participate in clinical peer review recruitment and supervision. Collaborate with Provider Relations to ensure adequate provider credentialing. Contribute to BH quality profiles and data analysis. Develop and oversee the BH sections of the Quality Management/Utilization Management plan. Oversee performance improvement activities, grievances, and appeals. Attend quarterly leadership and medical director meetings. Coordinate with other child-serving systems like education and foster care. Conduct reviews of claims and appeals related to medical quality. Ensure care standards meet acceptable medical practices. Implement clinical practice guidelines and evidence-based practices. Develop performance and quality initiatives to improve outcomes. Develop and interpret policies as needed. Participate in regulatory and community activities to stay informed on standards. Review pediatric cases in accordance with company policies. Support the company's mission, values, and privacy policies. Maintain high attendance and perform other duties as assigned. Note
This is an exempt position requiring flexible hours, including occasional evenings. Remote work is possible with compliance to company policies. Minimum Qualifications
NY licensed, board-certified in child and adolescent psychiatry, with no sanctions. At least 5 years working with children in BH managed care or clinical settings, including 2 years clinical experience. At least 10 years of medical experience with strong QM/UM knowledge. Ability to resolve complex medical issues and apply evidence-based medicine. Excellent interpersonal skills and basic electronic communication skills. Physical Requirements
Ability to travel across service regions as needed. We are committed to diversity, inclusion, and health equity. We encourage all qualified individuals to apply. Salary range: $202,000 - $303,000, commensurate with experience and qualifications.
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Join to apply for the
Medical Director, Children's Services (SafetyNet & Behavioral Health)
role at
Excellus BCBS This position provides clinical leadership for the development and implementation of the Children’s Behavioral Health (BH) Carve-In program, overseeing BH services for Medicaid Managed Care enrollees under age 21. Essential Responsibilities
Lead and develop the Children’s Behavioral Health Carve-In program following NYS guidelines. Perform medical necessity reviews, peer-to-peer calls, and support case management staff. Lead interdisciplinary care management rounds. Provide clinical oversight to Utilization Management/Case Management staff working with children. Develop and interpret clinical policies impacting children's health and wellbeing. Coordinate between BH and physical health care services. Participate in clinical peer review recruitment and supervision. Collaborate with Provider Relations to ensure adequate provider credentialing. Contribute to BH quality profiles and data analysis. Develop and oversee the BH sections of the Quality Management/Utilization Management plan. Oversee performance improvement activities, grievances, and appeals. Attend quarterly leadership and medical director meetings. Coordinate with other child-serving systems like education and foster care. Conduct reviews of claims and appeals related to medical quality. Ensure care standards meet acceptable medical practices. Implement clinical practice guidelines and evidence-based practices. Develop performance and quality initiatives to improve outcomes. Develop and interpret policies as needed. Participate in regulatory and community activities to stay informed on standards. Review pediatric cases in accordance with company policies. Support the company's mission, values, and privacy policies. Maintain high attendance and perform other duties as assigned. Note
This is an exempt position requiring flexible hours, including occasional evenings. Remote work is possible with compliance to company policies. Minimum Qualifications
NY licensed, board-certified in child and adolescent psychiatry, with no sanctions. At least 5 years working with children in BH managed care or clinical settings, including 2 years clinical experience. At least 10 years of medical experience with strong QM/UM knowledge. Ability to resolve complex medical issues and apply evidence-based medicine. Excellent interpersonal skills and basic electronic communication skills. Physical Requirements
Ability to travel across service regions as needed. We are committed to diversity, inclusion, and health equity. We encourage all qualified individuals to apply. Salary range: $202,000 - $303,000, commensurate with experience and qualifications.
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