Buckeye Health Plan
Part-time Behavioral Health Medical Director - Ohio
Buckeye Health Plan, Frankfort, Kentucky, United States
Overview
Part-time Behavioral Health Medical Director - Ohio at Buckeye Health Plan. Join to apply for the Part-time Behavioral Health Medical Director - Ohio role at Buckeye Health Plan. This role supports the Medical Management/Health Services team and involves medical leadership to optimize quality and cost-effectiveness of care for members. Responsibilities
Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform medical review activities related to utilization review, quality assurance, and review of complex, controversial, or experimental medical services to ensure timely and quality decisions. Support the implementation of performance improvement initiatives for capitated providers. Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assist the Chief Medical Director with the functioning of physician committees, including structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborate with clinical teams, network providers, appeals team, and medical/pharmacy consultants for reviewing complex cases and medical necessity appeals. Participate in provider network development and, as appropriate, new market expansion. Assist in the development and implementation of physician education regarding clinical issues and policies. Identify utilization review studies and evaluate adverse utilization trends, unusual provider practice patterns, and adequacy of benefit/payment components. Identify clinical quality improvement studies to reduce unwarranted variation and improve quality and cost of care. Interface with physicians and other providers to facilitate implementation of recommendations that improve utilization and health care quality. Review claims involving complex, controversial, or unusual/new services to determine medical necessity and appropriate payment. Develop alliances with the provider community through the development and implementation of medical management programs. Represent the business unit before public groups on medical philosophy, policies, and related issues as needed. Represent the business unit at appropriate state and ad hoc committees as needed. May be required to work weekends and holidays in support of business operations, as needed. Education/Experience
Medical Doctor (MD) or Doctor of Osteopathy (DO). Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications
Board certification in general psychiatry or child psychiatry. 5+ years of experience in behavioral health managed care or behavioral health clinical settings, with at least 2 years in a clinical setting. Certification in addiction medicine or addiction psychiatry preferred. Current Ohio state license as an MD or DO without restrictions, limitations, or sanctions from government programs. Pay and Benefits
Pay Range: $221,300.00 - $420,500.00 per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may include additional incentives. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer that is committed to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Notes
Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.
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Part-time Behavioral Health Medical Director - Ohio at Buckeye Health Plan. Join to apply for the Part-time Behavioral Health Medical Director - Ohio role at Buckeye Health Plan. This role supports the Medical Management/Health Services team and involves medical leadership to optimize quality and cost-effectiveness of care for members. Responsibilities
Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform medical review activities related to utilization review, quality assurance, and review of complex, controversial, or experimental medical services to ensure timely and quality decisions. Support the implementation of performance improvement initiatives for capitated providers. Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assist the Chief Medical Director with the functioning of physician committees, including structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborate with clinical teams, network providers, appeals team, and medical/pharmacy consultants for reviewing complex cases and medical necessity appeals. Participate in provider network development and, as appropriate, new market expansion. Assist in the development and implementation of physician education regarding clinical issues and policies. Identify utilization review studies and evaluate adverse utilization trends, unusual provider practice patterns, and adequacy of benefit/payment components. Identify clinical quality improvement studies to reduce unwarranted variation and improve quality and cost of care. Interface with physicians and other providers to facilitate implementation of recommendations that improve utilization and health care quality. Review claims involving complex, controversial, or unusual/new services to determine medical necessity and appropriate payment. Develop alliances with the provider community through the development and implementation of medical management programs. Represent the business unit before public groups on medical philosophy, policies, and related issues as needed. Represent the business unit at appropriate state and ad hoc committees as needed. May be required to work weekends and holidays in support of business operations, as needed. Education/Experience
Medical Doctor (MD) or Doctor of Osteopathy (DO). Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications
Board certification in general psychiatry or child psychiatry. 5+ years of experience in behavioral health managed care or behavioral health clinical settings, with at least 2 years in a clinical setting. Certification in addiction medicine or addiction psychiatry preferred. Current Ohio state license as an MD or DO without restrictions, limitations, or sanctions from government programs. Pay and Benefits
Pay Range: $221,300.00 - $420,500.00 per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may include additional incentives. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer that is committed to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Notes
Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.
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