Job Description

Job Title: Associate Medical Director - CCBH
Job ID: 613437
Status: Full-Time
Regular/Temporary: Flex
Hours:
Shift: Day
Facility: Community Care Behavioral Hlth
Department: Peer AdvPerf Mgmt Sat NE
Location: 72 Glenmaura National Boulevard, Moosic PA 18507

Description

Community Care Behavioral Healthcare Organization (CCBHO) is seeking a qualified individual to fulfill the role of Associate Regional Medical Director and offer administrative services involving 7 counties in Northeast Pennsylvania including the Pocono region. This individual would report to the Senior Medical Director of CCBHO and offer clinical and medical supervision to the care management and quality clinician staff in 2 of our offices, Moosic (near Scranton) and Tobyhanna (near Mount Pocono), Pennsylvania. Though many of the duties can be provided on a remote basis, there would be a need for being on site approximately or a minimum of once per month.

 
CCBHO is part of the UPMC healthcare system and compensation and benefits are highly competitive and is based in part on attaining 1 or more board certification status. Duties could be individualized and be offered within a weekly time frame of 28 to 40 of usual working hours. There are no requirements for on-call, weekend or evening hours.


The Associate Regional Medical Director would join a highly educated and motivated team of physician advisors at CCBHO who advocate well for the recovery from mental health and substance use disorders for nearly a million individuals across Pennsylvania. He or she would have the opportunity to be involved in many new initiatives some of which lend towards research and journal inclusion.


The Associate Regional Medical Director is responsible for assuring the quality and efficiency of the health care delivered to Community Care members. This includes significant responsibility for quality management and utilization management and for helping to evaluate the adequacy of the provider network for the clinical needs of Community Care members. In addition, the Regional Medical Director is a resource to participating providers in the provision of quality medical care.

Responsibilities:

  • Acts as a liaison for Community Care with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services.
  • Acts as a physician reviewer for cases referred by care management staff.
  • Advises the Regional Medical Director on the development and review of programs, positions, and budgets having an impact on clinical services.
  • Assures effective and appropriate utilization of the various levels of care in the provider network.
  • Assures psychiatric involvement in the development, approval, and review of all policies, procedures, and protocols governing clinical care.
  • Assures the quality of treatment and related services provided by Community Care professional staff, through participation (directly or by designee) in the ongoing quality management and audit processes.
  • Develops and maintains effective relationship with providers.
  • Ensures prompt and fair resolution of care management decision appeals.
  • Ensures the quality of clinical care provided to Community Care members.
  • Implements quality management programs and continuing education activities.
  • Interfaces with physician consultants and provides direction for the physician consultants.
  • Meets or exceeds NCQA, URAC or other regulatory standards.
  • Participates in the appropriate committees of physical health HMO's where applicable, such as a pharmacy and therapeutics committee.
  • Reviews complaints and grievances in accordance with Community Care procedures, and assures prompt response and action at all stages of the complaint and grievance process.
  • Reviews proposed service denials and supervises care managers in the utilization of appropriate medical necessity criteria, and ensures appropriate care management integration and coordination.
  • Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System.
  • Supports member satisfaction with the care management process.
  • Supports provider satisfaction with the care management process.
  • Works closely with the medical directors of physical health HMO's to assure coordination between physical health and behavioral health needs and services.
  • Works with Provider Relations to enhance the working relationship between Community Care and the providers in its network
  • Works with Quality Management in designing and evaluating quality initiatives.

Qualifications

  • Board Certification in Psychiatry required
  • Minimum 8 years clinical experience required.
  • Experience in Behavioral Health treatment and program development. 
  • At least 5 years of management experience preferred. 
  • Experience in managed care setting preferred.  
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school.
  • Ability to obtain an Unrestricted License in Pennsylvania. 
  • Post residency clinical experience. 
  • Ability to implement medical policies, and to enforce those policies through appropriate action.  
  • Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care. 
  • Ability to implement programs of quality care analysis, peer review, and professional education.

Licensure, Certifications, and Clearances:
Board Certification in Psychiatry required (a second Board certification is helpful but not required.)

  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance
  • Doctor of Osteopathy or Medical Doctor

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Union Position: No

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