Adoloscent Behavior Medical Director, part-time
Company: Home State Health Plan
Location: Saint Joseph
Posted on: June 24, 2022
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Job Description:
You could be the one who changes everything for our 26 million
members. Centene is transforming the health of our communities, one
person at a time. As a diversified, national organization, you---ll
have access to competitive benefits including a fresh perspective
on workplace flexibility Purpose: Assist the Chief Medical Director
to direct and coordinate the medical management, quality
improvement and credentialing functions for the business unit.
Provides medical leadership of all for utilization management, cost
containment, and medical quality improvement activities. Performs
medical review activities pertaining to utilization review, quality
assurance, and medical review of complex, controversial, or
experimental medical services. Supports effective implementation of
performance improvement initiatives for capitated providers.
Assists Chief Medical Director in planning and establishing goals
and policies to improve quality and cost-effectiveness of care and
service for members. Provides medical expertise in the operation of
approved quality improvement and utilization management programs in
accordance with regulatory, state, corporate, and accreditation
requirements. Assists the Chief Medical Director in the functioning
of the physician committees including committee structure,
processes, and membership. Oversees the activities of physician
advisors. Utilizes the services of medical and pharmacy consultants
for reviewing complex cases and medical necessity appeals.
Participates in provider network development and new market
expansion as appropriate. Assists in the development and
implementation of physician education with respect to clinical
issues and policies. Identifies utilization review studies and
evaluates adverse trends in utilization of medical services,
unusual provider practice patterns, and adequacy of benefit/payment
components. Identifies clinical quality improvement studies to
assist in reducing unwarranted variation in clinical practice in
order to improve the quality and cost of care. Interfaces with
physicians and other providers in order to facilitate
implementation of recommendations to providers that would improve
utilization and health care quality. Reviews claims involving
complex, controversial, or unusual or new services in order to
determine medical necessity and appropriate payment. Develops
alliances with the provider community through the development and
implementation of the medical management programs. As needed, may
represent the business unit before various publics both locally and
nationally on medical philosophy, policies, and related issues.
Represents the business unit at appropriate state committees and
other ad hoc committees For NH Substance Use Disorder Physician:
Provides clinical oversight and guidance for the MCO on Substance
Use Disorder issues, including issues such as the use of ASAM or
other evidence-based assessments and treatment protocols, the use
of MAT, engagement with PRSS, and discharge planning for members
who visit an ED or are hospitalized for an overdose. Consults on
MCO clinical policy related to Substance Use Disorders and the
cases of individual members for the MCM program on a routine basis.
Education/Experience: Medical Doctor or Doctor of Osteopathy. 7
years of clinical experience in the practice of medicine.
Utilization Management experience and knowledge of quality
accreditation standards preferred. Actively practices medicine.
Course work in the areas of Health Administration, Health
Financing, Insurance, and/or Personnel Management is advantageous.
Experience treating or managing care for a culturally diverse
population preferred. License/Certifications: Board certification
by the American Board of Psychiatry and Neurology. Current Missouri
state medical license without restrictions. Our Comprehensive
Benefits Package: Flexible work solutions including remote options,
hybrid work schedules and dress flexibility Competitive pay Paid
Time Off including paid holidays Health insurance coverage for you
and dependents 401(k) and stock purchase plans Tuition
reimbursement and best-in-class training and development Centene is
an equal opportunity employer that is committed to diversity, and
values the ways in which we are different. All qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, disability, veteran status, or other characteristic
protected by applicable law.
Keywords: Home State Health Plan, Saint Joseph , Adoloscent Behavior Medical Director, part-time, Executive , Saint Joseph, Missouri
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