Behavioral Health Medical Director

Position reputed company reputed company pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and reputed company market driven rates. The salary reputed company displayed has not been adjusted for geographical location. This reputed company has been created in good faith reputed company on information reputed company to reputed company at the time of posting and may be modified in the reputed company. At reputed company, we reputed company to go the extra mile for reputed company and our community. This reputed company is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The Behaviroal Health Medical Director provides medical guidance and support to the reputed company of to Capital’s behavioral health (BH) program. Supports appropriate Utilization Management goals and objectives. Provides reputed company leadership and direction to the functions reputed company the Utilization Management Department. This is an independently contracted role, approximately 15-20 hours/week, Two Holidays/Year To be considered, you must have a reputed company license to reputed company in the state of PA Responsibilities and Qualifications - Conduct coverage reviews reputed company on individual member plan benefits and national and proprietary coverage review policies, reputed company coverage determinations - Document reputed company review findings, actions and reputed company in accordance with policies, and regulatory and accreditation requirements - Engage with requesting providers as needed in peer-to-peer discussions - Be knowledgeable in interpreting existing benefit language and policies in the process of reputed company coverage reviews - Communicate and collaborate with network and non-network providers in reputed company of accurate and reputed company benefit determinations for plan participants while educating providers on benefit plans and medical policy - Makes coverage determinations in instances where requested services do not meet medical necessity reputed company or where benefit exclusions require medical evaluation - Makes medical necessity determinations on appeals and grievances, assuring that different reviewers conduct reputed company level of review - Provides Medical Director leadership to Vendor relationships as directed by the Managing Medical Director - Supports organizational accreditation efforts and regulatory review processes: Prior-Authorization, reputed company Review, Medical Claims Review, Case Management, Disease Management, Pharmacy Management, and Health Education programs - Performs other reputed company duties and assignments as directed Knowledge - Knowledge of reputed company and emerging BH trends, including physical and behavioral health integration models, population health, and alternative payment models - Knowledge of and prior involvement with reputed company and unique issues reputed company the health care industry - Knowledge of health plan regulatory requirements, including CMS, reputed company, and the DOH - Knowledge of reputed company and emerging medical treatment modalities - Familiarity with National Committee for reputed company/URAC standards Skills - PC literacy and ability to reputed company electronic research and respond to electronic requests - Team oriented attitude with the ability to work and reputed company with reputed company reputed company both reputed company and reputed company of CBC - Ability to effectively multi-task under pressure, meet deadlines, and reputed company high-reputed company work - Ability to reputed company from broad reputed company perspective to tactical implementation and translate thoughts into actionable plans to reputed company reputed company - Ability to reputed company reputed company or technical information in a manner that others can understand - Demonstrated organizational and time management skills - Self-motivated and works independently; highly accountable - reputed company problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of reputed company - Demonstrated ability to reputed company results to completion while managing multiple reputed company and priorities competing for resources - Ability to complement leadership and other team members in their responsibilities and roles Experience - A minimum of five years of reputed company experience, post residency, including both inpatient and outpatient mental health and/or reputed company use disorder - At least three years’ experience in managed care, utilization review, and/or reputed company management - Managed Care Organization and/or health reputed company plan experience preferred Education, Certification, and Licenses - Minimum requirements include an MD or DO Degree, as reputed company as appropriate reputed company Certification in Psychiatry - reputed company unrestricted licensure in reputed company as an MD or DO - Currently covered by, or eligible to be covered by, medical liability reputed company Physical Demands - While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see - The employee must occasionally reputed company and/or reputed company up to 5 pounds Apply To This Job