Job Summary:
The Associate Medical Director, Behavioral Health supports staff by providing training, clinical consultation, and clinical case reviews members.
Essential Functions:
- Participate in peer-to-peer discussions
- Provide provider education, training, data sharing, performance evaluations and orientation to the plan
- Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
- Participate in development of policies and procedures
- Provide cross-coverage for other Medical Directors and/or markets, as needed
- Provide prior authorization medical reviews, consultation and clinical review services
- Conduct clinical reviews for designated CareSource members
- Conduct Clinical Appeals
- Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
- Perform any other job related instructions, as requested
Education and Experience:
- Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
- Successful completion of a residency training program in psychiatry is required
- Minimum of three (3) years of clinical practice experience is required
- Experience in safe prescribing is required
- Managed care medical review/medical director experience is preferred
Competencies, Knowledge and Skills:
- Basic Microsoft Word skills
- Excellent communication skills, both written and oral
- Ability to work well independently and within a team environment
- Ability to create strong relationships with Providers and Members
- High ethical standards
- Attention to detail
- Critical listening and systematic thinking skills
- Ability to maintain confidentiality and act in the company’s best interest
- Ability to act with diplomacy and sensitivity to cultural diversity
- Decision making/problem solving skills
- Conflict resolution skills
- Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
Licensure and Certification:
- Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
- Board Certification in Psychiatry is required
- Re-certification, as required by specialty board, must be maintained
- MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions:
- General office environment; required to use general office equipment
- May be required to work evenings/weekends
- May be required to travel to fulfill duties of position
Compensation Range:
$195,200.00 - $341,600.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-SW2