GENERAL SUMMARY
Provides medical leadership and oversight to Medical Directors in the behavioral health division in order to provide excellent quality of care and service to our members that is cost efficient.
ESSENTIAL RESPONSIBILITIES
- Provides direction and oversight to Medical Directors in the behavioral health division.
- Provides technical expertise in medical management by direct decision making in the areas of preauthorization, concurrent review of hospitalized patients, discharge planning, and complex case management.
- Oversees the development and implementation of Clinical Practice Guidelines for specific diagnoses as well as Medical Necessity Criteria.
- Responsible for the development and implementation of the organization’s Utilization Improvement and Quality Improvement programs in accordance with company policy and procedure and according to accreditation standards.
- Chairs (or staffs) all peer-review committees such as Quality Improvement, Credentialing and others that are deemed appropriate for the health plan.
- Analyzes medical cost drivers and develops specific plans to reduce excessive cost.
- Partners with Health Plan medical leadership, to review pharmacy benefits and formularies, and to coordinate behavioral medicine educational opportunities for non-psychiatrist participating providers as requested.
- Works with the division CEO to develop strategic approaches to improve company performance and expand growth by optimizing the provider network, evaluating provider (hospital, physician, ancillary) contracts, and developing other creative approaches.
- Provides guidance and is responsible for all clinical aspects of the program.
- Has periodic consultation with practitioners in the field as necessary.
- Ensures a staff of qualified clinicians accountable to the organization for decisions affecting consumers is maintained, and that appeals are reviewed by non-subordinate board certified specialists.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:JOB SPECIFICATIONS
- Formal education including an MD or DO degree required.
- Employee must hold and maintain an active unrestricted clinical license to practice medicine as required by state law.
- Board certification is required.
- Previous (2 years) patient care experience in behavioral health required.
- Previous (2 years) experience as a managed care Medical Director or equivalent.
- Experience with government business required
- Expert clinical knowledge and skills.
- Strong written and verbal communication skills.
- Demonstrated leadership skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Austin, TX, US
Organization: 51000 - MHNet Specialty Services, LLC
Schedule: Full-time
Job Posting: 2012-12-11 00:00:00.0
Job ID: 1212458
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.