Adoloscent Behavior Medical Director, part-time
Company: Home State Health Plan
Location: Joplin
Posted on: June 20, 2022
Job Description:
You could be the one who changes everything for our 26million
members. Centene is transforming the health of our communities, one
person at a time. As a diversified, nationalorganization, youll
have access to competitive benefits including a fresh perspective
on workplace flexibilityPurpose: 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 flexibilityCompetitive payPaid Time
Off including paid holidaysHealth insurance coverage for you and
dependents401(k) and stock purchase plansTuition reimbursement and
best-in-class training and developmentCentene 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.by Jobble
Keywords: Home State Health Plan, Joplin , Adoloscent Behavior Medical Director, part-time, Executive , Joplin, Missouri
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