Medical Director - Psychiatry Richmond, VA 47898117-41a6-459f-af7b-e19d73255c6d 2019-07-26T14:04:24.740-04:00 Leading health plan seeks a Medical Director - Psychiatry, to oversee the utilization management plan for various Virginia affiliated health plans. The Medical Director - Psychiatry should be and M.D. or D.O. with a speciality in psychiatry, and an active Virginia medical license. Requirements for the Medical Director Psychiatry: * M.D. or D.O. licensure in Virginia, ABMS board certification in psychiatry * Completion of psychiatric residency in the U.S. or Canada, approved by the ACGME * 5+ years post residency clinical psychiatric care experience * Experience in managed care, health plans Responsibilities for the Medical Director - Psychiatry: * Develop and implement a Utilization Management program and action plan. * Manages UM practices including over and under utilization, evaluating UM practices and criteria. * Provide direct support to UM and clinical care teams. * With corporate clinical team implements clinical practice standards and policies and participates in management of activities. * Develop, implement and interpret medical policy, technology assessments, and medical necessity guidelines. * Develop working relationships with practitioners, provider facilities, treatment programs, conferring directly with psychiatrists and other practitioners regarding the care of patients with severe, complex, and/or treatment resistant illnesses. * Ensures that contract requirements, accreditation standards (e.g. NCQA), state policies and federal policies are implemented specific to each client. * Work with teams on continuous quality improvement to ensure ongoing compliance in utilization and case management. * Participate in and maintain the integrity of the appeals process, both internally and externally. * Investigate adverse incidents and quality of care concerns. * Participate in preparation for NCQA and URAC certifications. * Develop and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead senior medical director, and quality improvement staff.
* M.D. or D.O. licensure in Virginia, ABMS board certification in psychiatry * Completion of psychiatric residency in the U.S. or Canada, approved by the ACGME * 5+ years post residency clinical psychiatric care experience * Experience in managed care, health plans
Associated topics: care, community, demand, demand generation, endowment, hospital, policies, product market, public relations, social media