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Regional Medical Director CCB

  • Job ID: 266591162
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Peer Adv_Perf Mgmt-Sat
  • Location: 200 Corporate Drive, Camp Hill PA 17011
  • Union Position: No
  • Salary Range: $0 / hour

Description

Community Care Behavioral Health Organization (Community Care) is seeking a qualified psychiatrist to fulfill the role of Regional Medical Director and offer administrative services in our Capital Regional Office. The 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 assuring the adequacy of the provider network for the clinical needs of Community Care members. The Medical Director also participates in regional leadership policy decisions and strategic planning. In addition, the Regional Medical Director is a resource to participating providers in the provision of quality medical care.This psychiatrist would report to the Senior Medical Director and provide clinical and medical supervision to the care management and quality management staff in our office in Camp Hill, Pennsylvania.

Community Care is a public behavioral health managed care organization (BH-MCO) that is part of the UPMC Insurance Division that is both NCQA and URAC accredited. Compensation and benefits are highly competitive and are based in part on attaining one or more board certification status. Duties could be individualized and be offered within a weekly time frame of 32 to 40 of usual working hours. There are no requirements for on-call, weekend or evening hours.

The Regional Medical Director would join a highly educated, collegial and motivated team of physician advisors 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 of the new initiatives that include targeting enhanced service delivery for specific populations, physical health/ behavioral health integration, substance use treatment, residential treatment for children, prescribing trends; some of which could result in presentations and or journal publication.
Child and adolescent psychiatrists, adult psychiatrists as well as psychiatrists with additional subspecialty training are welcome to apply.

Responsibilities:
  • Assures psychiatric involvement in the development, approval, and review of all policies, procedures, and protocols governing clinical care.
  • Interfaces with the Counties and DPW as indicated.
  • Ensures the quality of clinical care provided to Community Care members
  • Supports provider satisfaction with the care management process.
  • 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.
  • Reviews of complaints and grievances in accordance with Community Care procedures, and to assure prompt response and action at all stages of the complaint and grievance process.
  • Meets or exceeds NCQA, URAC or other regulatory standards
  • Interfaces with the Physical Health MCO's through Medical Director to Medical Director meetings, and sits on appropriate committees of the PH MCOs.
  • Develops and maintains effective relationships with providers.
  • Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System.
  • Participates in the appropriate committees of physical health HMO's where applicable, such as a pharmacy and therapeutics committee.
  • Advises the Regional Director on the development and review of programs, positions, and budgets having an impact on clinical services.
  • Works with Quality Management in designing and evaluating protocols.
  • Ensures prompt and fair resolution of care management decision appeals.
  • Works with Provider Relations to enhance the working relationship between Community Care and the providers in its network.
  • Reviews proposed service denials and supervises care managers in the utilization of appropriate medical necessity criteria, and ensures appropriate care management integration and coordination.
  • Interfaces with physician consultants and provides direction for the physician consultants.
  • Implements quality management programs and continuing education activities.
  • Acts as a physician reviewer for cases referred by care management staff.
  • 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.
  • Assures effective and appropriate utilization of the various levels of care in the provider network.
  • Supports member satisfaction with the care management process

Qualifications

  • Minimum ten (10) years clinical experience. 
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school. 
  • Unrestricted Licensee in Pennsylvania. 
  • Board Certification in Psychiatry, 
  • A second Board certification is helpful, but not required. 
  • Experience in Behavioral Health treatment and program development. 
  • Post residency clinical experience 
  • At least five (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. 
  • Quality of clinical care provided to COMMUNITY CARE members. 
  • Effective and appropriate utilization of the various levels of care in the provider network. 
  • Member satisfaction with the care management process. 
  • Provider satisfaction with the care management process. 
  • Meeting or exceeding NCQA standards and other applicable benchmarks. 
  • Prompt and fair resolution of care management decision appeals. 
  • Development and maintenance of effective relationships with providers.


Licensure, Certifications, and Clearances:

  • Board Certification in Psychiatry
  • Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct