The Behavioral Health Medical Director provides clinical oversight and direction to the Clinical Department. He/she is the designated behavioral health care practitioner with oversight of the Quality Improvement (QI) program. The Behavioral Medical Director is an active participant in QI Committee meetings providing clinical consultation, and holds final authority for recommendations for medical necessity and appropriateness or quality of care decisions. The Behavioral Medical Director reviews and approves the Outcomes Management and Quality Improvement Plan. This position is responsible for providing consultation and determinations for clinical cases in need of review. The Behavioral Health Medical Director supports the clinical department in applying Medical Necessity Criteria, to render determinations to requests for specific intensity of service. In addition, the Behavioral Health Medical Director will assess clinical aspects of specific cases and provide feedback to Care Managers pertaining to best practice standards and quality of care issues. This position assists in the development of Medical Necessity Criteria and performs utilization management activities. Assures that organizational medical policies and procedures adhere to contractual obligations.
MD or DO
Required from an accredited educational program in Social Work, Clinical Counseling, Psychology, or Behavioral Clinical Specialty.
Board Certified Psychiatrist
Minimum of 5 years of experience with psychiatric and addictive disease consumers.
10 or more years post-graduate clinical experience.
Amerihealth Caritas Health Plan