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Psychiatrist/ Behavioral Medical Director Chart Review

Company: Aurora Linda Healthcare
Location: Baton Rouge
Posted on: January 11, 2019

Job Description:

Job DescriptionAssist 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 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 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 REQUIREMENTS
    • Medical Doctor or Doctor of Osteopathy, board certified in psychiatry.
    • 3–5 years experience working in a behavioral health managed care setting or a behavioral health clinic settings.
    • Shall have appropriate training and expertise in general psychiatry and/or addiction disorder.
    • Previous experience within a managed care organization is preferred.
    • Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred.
    • Experience treating or managing care for a culturally diverse population preferred. Company DescriptionHealthcare recruitment focused on Psychiatrists, Physicians and IT.

      Keywords: Aurora Linda Healthcare, Baton Rouge , Psychiatrist/ Behavioral Medical Director Chart Review, Executive , Baton Rouge, Louisiana

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