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Associate Medical Director - CCBH

  • Job ID: 639707952
  • Status: Full-Time
  • Regular/Temporary: Flex
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Peer AdvPerf Mgmt Sat NE
  • Location: 72 Glenmaura National Boulevard, Moosic PA 18507
  • Union Position: No
  • Salary Range: $0 / hour

Description

Community Care Behavioral Health (CCBH) is seeking a qualified Psychiatrist 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 CCBH 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 periodic onsite work.

CCBH is part of the UPMC healthcare system and compensation and benefits are highly competitive. 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 CCBH who advocate well for the recovery from mental health and substance use disorders for nearly a million individuals across Pennsylvania. They 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 physician reviewer for cases referred by care management staff.
  • Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System.
  • Supports provider satisfaction with the care management process.
  • Interfaces with physician consultants and provides direction for the physician consultants.
  • 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.
  • Supports member satisfaction with the care management process.
  • Participates in the appropriate committees of physical health HMO's where applicable, such as a pharmacy and therapeutics committee.
  • Works closely with the medical directors of physical health HMO's to assure coordination between physical health and behavioral health needs and services.
  • Acts as a liaison for Community Care with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services.
  • Implements quality management programs and continuing education activities.
  • Works with Provider Relations to enhance the working relationship between Community Care and the providers in its network
  • Ensures prompt and fair resolution of care management decision appeals.
  • Meets or exceeds NCQA, URAC or other regulatory standards.
  • Reviews proposed service denials and supervises care managers in the utilization of appropriate medical necessity criteria, and ensures appropriate care management integration and coordination.
  • Assures effective and appropriate utilization of the various levels of care in the provider network.
  • Ensures the quality of clinical care provided to Community Care members.
  • Advises the Regional Medical Director on the development and review of programs, positions, and budgets having an impact on clinical services.
  • Assures psychiatric involvement in the development, approval, and review of all policies, procedures, and protocols governing clinical care.
  • Develops and maintains effective relationship with providers.
  • 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.
  • Works with Quality Management in designing and evaluating quality initiatives.

Qualifications

  • Minimum 8 years clinical experience.Doctor of Medicine or Doctor of Osteopathy from an accredited school.
  • Unrestricted License in Pennsylvania.
  • Post-residency clinical experience.
  • Experience in Behavioral Health treatment and program development.
  • At least 5 years of management experience preferred.
  • Experience in managed care setting preferred.
  • 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
  • Board Certification in Psychiatry
  • Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

UPMC is an Equal Opportunity Employer/Disability/Veteran

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