{"id":1984,"date":"2016-02-29T03:29:28","date_gmt":"2016-02-29T03:29:28","guid":{"rendered":"http:\/\/nexushc.com\/?p=1984"},"modified":"2018-04-13T22:16:09","modified_gmt":"2018-04-13T22:16:09","slug":"psychiatrist-medical-director-behavioral-health-az","status":"publish","type":"post","link":"http:\/\/nexushc.com\/?p=1984","title":{"rendered":"Psychiatrist\/ Medical Director \u2013 Behavioral Health (OH, AZ)"},"content":{"rendered":"

Ohio, Arizona<\/span><\/p>\n

The Psychiatric Medical Director will assist the Chief Medical Officer to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.<\/p>\n

\u2022 Provides medical leadership for Medicare utilization management activities, Organizational Determinations, and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants
\n\u2022 Performs case reviews and appeals for all health plans
\n\u2022 Facilitates Grand Rounds and case reviews with other clinicians and external treating providers
\n\u2022 Participates as an active member of the Integrated Care team (ICT)
\n\u2022 In collaboration with the VP of Clinical Programs, develops clinical programs and approaches targeted
\nto improve health outcomes for complex care and high acuity populations
\n\u2022 Assists VP of Clinical Programs in planning, establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
\n\u2022 Provides medical expertise in the operation of approved quality improvement and utilization
\nmanagement programs in accordance with regulatory, state, corporate, and accreditation
\nrequirements.
\n\u2022 Identifies utilization review studies and evaluates adverse trends in utilization of medical services,
\nunusual provider practice patterns, and adequacy of benefit\/payment components.
\n\u2022 Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical
\npractice in order to improve the quality and cost of care.
\n\u2022 Reviews claims involving complex, controversial, or unusual or new services in order to determine
\nmedical necessity and appropriate payment<\/p>\n

Requirements<\/strong>
\n\u2022 Must be an actively practicing physician or willing to practice 4 hrs\/wk
\n\u2022 MD or DO from an accredited medical school
\n\u2022 Board certification in psychiatry by the Board of Psychiatry and Neurology
\n\u2022 Experience treating or managing care for a culturally diverse population preferred
\n\u2022 Previous experience within a managed care organization required<\/p>\n

  
\nApply Now<\/span><\/a><\/p>\n

Not sure if you want to apply?
\nContact us for more info:
\nRebecka Boyd
\n804-502-0870
\n nexusexecutivesearch@gmail.com<\/a><\/span><\/p>\n