Medical Director - Behavioral Health

Location: Las Vegas, NV
Job Type: Direct Hire
Salary: $205,000.00 - $267,000.00
Degree: Medical Doctor; Doctor of Osteopathy;
Date: 8/16/2017
Job ID: 02493962
Job Description
Medical Director - Behavioral Health
Seeking a Medical Director who is Board Certified as a Medical Doctor or Doctor of Osteopathy, board certified in Psychiatry. Board Certification must be through an approved ABMS Board: Board certified by the American Board of Psychiatry and Neurology. Current state medical license without restrictions.

Only actively practicing physicians will be considered, preferably in the 3rd or 4th quarter of their career and are looking for a change to be working in Utilization Review, great work/life balance, no more On Call or weekends.

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.
Regional relocation is available. Our client is located in the Henderson, NV region… so you would need to live in the region. There is a Performance Bonus of 20% or possibly higher. Since the work you would be doing will involve Utilization review work in multiple states, it is required you do not have a restricted license. You will not have any direct reports in this role. Salary starts at $ 205,000 and goes up depending on experience.
Our client provides health insurance solutions for the under-insured and uninsured, and through specialty services. Our client is a firm believer in focusing on the whole health of a person.

It is a plus if you have the following, but NOT required: 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.
In this role:
•           You have the opportunity to utilize all of your years of clinical practice to assist the Chief and Senior Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. This includes health plans through Medicaid, Medicare and the Health Insurance Marketplace.
•           You will oversee the activities of physician advisors who are reviewing complex cases and medical necessity appeals.
•           You will perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. You could be reviewing claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
•           Identify and implement clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
Benefits:
•           Our client offers outstanding health insurance benefits: paying most of your benefits costs and in some cases –  pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
•           401(k) retirement with company match and Employee stock purchase plan
They also offer:  Vacation, Personal and Sick time, Paid Company Holidays , Employee Assistance Program (EAP),  Training and Learning Opportunities,  Tuition Reimbursement/Educational Assistance , On-site fitness center or discount at local fitness centers (most locations),  Discounts for select local and national products and services, including cell phones, computers and more.
 



Position Purpose: Assist the Senior 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 Senior 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
Qualifications:
Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified in psychiatry.
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.
The candidate must be an actively practicing physician.
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.


License/Certifications: Board certified by the American Board of Psychiatry and Neurology. 
Current state medical license without restrictions.


*Please email us your resume along with the best days and times to reach you. We look forward to discussing this exciting and rewarding opportunity.?

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.