Behavioral Health Medical Director

November 28

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Acentra Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

⚕️ Healthcare Insurance

💳 Fintech

Description

•CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. •Lead the Way is our rallying cry at Acentra Health. •Acentra is looking for a Part-Time Behavioral Health Medical Director to join our growing team. •The Part-Time Behavioral Health Medical Director shall provide the clinical and administrative medical oversight for Behavioral Health Utilization Management reviews. •The Medical Director will provide leadership to the Behavioral Health physician reviewers. •Moreover, the Medical Director will provide clinical determinations on behavioral health service requests utilizing nationally recognized criteria, clinical expertise. •Evaluate, redirect, and/or respond to inquiries from physicians, providers, and customers. Consult with general and/or specialty practitioners regularly and as necessary as business needs require. •Respond to telephone calls and letters to foster appropriate external relationships with attending physicians/ surgeons/behavioral health providers. •Analyze and remain current on national, state, and local regulations and legislation that impact the healthcare profession. •Review pediatric medical literature, information trends, experiences, and approaches, and assist in the development of strategic plans for clinical improvements. •Ensure compliance with regulatory and accreditation requirements. •Participate in activities specific to contractual arrangements remotely and in person, if required. •Provide medical expertise with respect to planning and establishing goals and policies to improve medical management. •Conduct peer-to-peer physician consultations as requested or required and document consultations. •Work with medical, nursing, and administrative staff to identify matters needing shared attention. •Discuss, inform, and facilitate communication and interaction between staff with customers. •Provide and review for medical necessity for services (e.g., PRTF, ABA, and Mental Health, including Psychiatry).

Requirements

•Psychiatrist (MD/DO) with a current non-restricted license to practice medicine by the Board of Medical Examiners. •10+ years of clinical practice. •2+ years as a Medical Director in a managed care company. •Board certification in a clinical specialty if MD or DO. •Experience in Utilization Management (UM) with knowledge of Medicaid and Medicare programs. •Prior Review experience or Quality Assurance committee responsibility in a hospital setting. •Utilization Management (UM) review experience. •Experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues. •A strong knowledge of Quality Assurance (QA) and Utilization Review (UR). •A contemporary clinician who understands major trends in healthcare and managed care. •Ability to work effectively with a diversity of personalities. Must be approachable, show respect for others, and build consensus. •A systems thinker with strong organizational skills who can pull all the pieces together and deliver on time and within budget. •Adaptable with a strong collaborative management style, a creative thinker with high energy and enthusiasm, and a team player who promotes the concepts of people working together. •Able to adapt to frequently changing work parameters.

Benefits

•We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. •You will have meaningful work that genuinely improves people's lives across the country. •Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.