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Medical Director-Behavioral Health - Sharp Health Plan | CA Licensed | Remote | Sign-on bonus eligible

Job ID JR122217 Date Posted 07/07/2022
San Diego, California
  • Health Plan
  • Day
  • Regular
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Responsibilities

Hours

Shift Start Time:

Variable

Shift End Time:

Variable

Additional Shift Information:

8

Weekend Requirements:

As Needed

On-Call Required:

No


What You Will Do
Working with the Plan Senior Medical Director, assists with overseeing behavioral health medical care for Sharp Health Plan (SHP) products and services. Is accountable for and provides professional leadership and direction to the utilization and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc. Works with all departments of Health Services to support, provides assistance and direction in overall medical management effectiveness. Works with Appeals and Grievances and Compliance to support all behavioral health needs. Reports all issues of clinical quality management to the Health Plan Senior Medical Director. Ensures that policies and systems are followed until agreed upon change is implemented. Works toward SHP strategic goals and objectives of ensuring a high quality of medical care for Plan members, staff empowerment, customer satisfaction, cost effectiveness, and market competitiveness

Required Qualifications

  • Doctor of Medicine (MD) Psychiatry or
  • Doctor of Osteopathic Medicine (DO) Psychiatry
  • 5 years of Psychiatry practice experience
  • California Physicians and Surgeons License - Medical Board of CA -REQUIRED


Preferred Qualifications

  • Previous experience as a physician executive in a managed care environment.


Essential Functions

  • Collaborates with the Plan Sr. Medical Director and Director of Medical Management, to guide and direct staff in relation to medical issues and departmental responsibilities. Assists in monitoring, reviewing, and evaluating the quality of health care services provided and communicates with PMGs and Plan providers as needed. Addresses physicians' issues and educates providers with regard to Plan policy, as needed.
  • Provides pre-admission review, utilization management, and concurrent and retrospective reviews as well as appeals.
  • Achieves and maintains benchmarked utilization management (UM) goals and clinical quality improvement (QI) objectives, in conjunction with the Plan Sr. Medical Director.
  • Assists the Plan Sr. Medical Director in advising the writing, revising and implementing health plan BH clinical policies, goals and objectives.
  • Supports NCQA accreditation activities. Assists the Plan Sr. Medical Director to prepare for site visits and responds to accrediting and regulatory agency feedback.
  • Participates in policy development and review, performs analysis and makes recommendations.
  • Assists the Plan Sr. Medical Director in creating and maintaining a system that gives feedback to providers, individually and collectively regarding managed care effectiveness of individual providers and networks.
  • Works collaboratively with the Utilization Management staff that is available after hours to respond to authorization requests for emergency and urgent services and is available, at a minimum, during normal working hours for inquiries and authorization requests for non- urgent health care services.
  • Education
    Promotes wellness and ensures programs of prevention, education and outreach to members and providers are consistent with SHP's mission, vision and values.
  • Human resource management
    Shares after-hours coverage responsibilities with other BH physicians.
    Represents SHP at medical group meetings, conferences, etc.
  • Plan Medical Director Support
    Responsible and accountable to the Plan Medical Director for helping to assure appropriate health care delivery for SHP's BH products and services. Reports organizationally to the Plan Medical Director.
    Performs other duties as requested or assigned.


Knowledge, Skills, and Abilities

  • Strong clinical background and skills. Solid understanding of utilization management and quality assurance activities and concepts.
  • Excellent communication skills, both verbal and written.
  • Strong interpersonal skills, including the ability to interface effectively with employees, members, physicians, senior management, and the public at large. Management skills to meet the organizational goals.
  • Knowledge of regulatory and accreditation agencies and requirements.
  • Able to manage multiple priorities and deadlines in an expedient and decisive manner. Able to manage difficult peer situations arising from medical care review. Appreciation of cultural diversity and sensitivity toward target population.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

#EC

California Physicians and Surgeons License - Medical Board of CA; Doctor of Osteopathic Medicine (DO); Doctor of Medicine (MD)
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