Part Time Medical Director - Behavioral Health
Provide leadership, technical expertise, and motivation in reshaping the healthcare delivery system to achieve efficiency, quality, and affordability of healthcare services. Provide leadership in thought, change management, and professional relations, to enhance and maintain relationships with physicians through Provider Profiling, Utilization Review Activities, and Quality Activities. Ensure organization is compliant with federal, state, and local laws, along with accreditation standards.
ESSENTIAL JOB FUNCTIONS:
- Provide leadership and technical expertise to enhance the company’s behavioral health care delivery system.
- Facilitate the implementation of Evidence Based Medicine, and the creation and operations of structures and processes to support high-quality cost-effective behavioral healthcare.
- Create processes for performance improvement and integrate individual patient-centered goals that attain affordable, high quality, medically necessary, and safe behavioral healthcare.
- Conduct prospective, concurrent, retrospective and appeals reviews of medical appropriateness and levels of care in accordance with state laws, regulations, and accrediting bodies.
- Build relationships with physicians and other providers to improve collaboration and align interests. Use this collaborative process to favorably enhance behavioral health care systems issues including but not limited to improving substance use disorder care, medication adherence, and fostering consistency of healthcare delivery across transitions of care and multiple providers
- Develop and conduct network quality initiatives to effect improvements in efficiency and quality of care in accordance with evidenced based medicine.
- Clinical advisor and liaison to case management including participation in clinical rounds.
- Conduct investigations and attend applicable physician and regulatory meetings for the Special investigations Unit upon request.
- Conduct Quality of Care reviews in accordance with departmental policies and procedures and assess and facilitate process improvements when appropriate to maintain efficiency and quality of the process.
- Provide educational opportunities for the medical and behavioral health staff consistent with expertise and clinical specialty. Seek input from clinical staff to create meaningful educational opportunities. Provide education to non-clinical staff (e.g regarding quality improvement, standards of preventive care).
- Conduct utilization review, credentialing, quality of care complaint and other activities as assigned.
- Represent BCBSRI on external committees and workgroups.
- Collaborate with BCBSRI government affairs on behavioral health related policy.
- Perform other duties as assigned.
Minimum Education and Experience:
- Board Certified Doctor of Medicine in psychiatry, with a current, unrestricted license to practice in Rhode Island or eligible for a Rhode Island license.
- Eight or more years of post-graduate experience in behavioral health practice.
Preferred Education, Additional Qualifications and Experience:
- Experience as an Associate or Medical Director in a health plan or behavioral health managed care organization
- Experience with presenting information to obtain acceptance at a senior management level
- Experience in leading a team
- Knowledge of health plan finance and reimbursement methodologies
Required Knowledge, Skills, and/or Abilities:
- Highly credible clinical expertise in chosen field
- Strong knowledge of managed care
- Centers for Medicaid and Medicare Services (CMS) and Medicare Advantage regulations, national Committee for Quality Assurance (NCQA) and RI Department of Health regulations. OHIC
- Knowledge of ASAM/SAMHSA principles and best practices
- Quality improvement principles
- Utilization management strategies
- Understanding of quality data; its strengths and limitations
- Methods to change provider behavior
- Strong analytical skills
- Strong problem-solving skills
- Strong persuasive skills required to negotiate, develop, influence, motivate, and change the behavior of others
- Strong presentation skills
- Strong written and oral communication skills
- Strong leadership skills
- Ability to work independently
- Ability to work in a fast-paced, changing environment
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- Pay Type Salary
- Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America