Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Medical Director- Behavioral Health Utilization Review

Expired Job

Newcareers Overland Park , KS 66204

Posted 2 months ago

We are in search of a Medical Director who is and actively practicing Board Certified Physician Board certified by the American Board of Psychiatry and Neurology.

This is a role where you are directing and coordinating the medical management, quality improvement and credentialing functions. You should be willing to practice clinically ONE day a week. Salary plus 20% bonus or higher

We can only consider those who are Board certified by the American Board of Psychiatry and Neurology. Current state medical license without restrictions.

Board certification in general psychiatry or child psychiatry. 5+ years of experience working in behavioral health managed care or behavioral health clinical settings, with at least 2 years in a clinical setting. Certification in addiction medicine or in the sub-specialty of addiction psychiatry preferred.

Our client may consider candidates requiring Visa Sponsorship.

Here is what a typical day would look like for you:

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 Chief 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.
This is NOT a remote opportunity. To be considered you should not currently have a non-compete clause in your current contract. This position reports to the Senior Director.

Our client is located in a suburb of St. Louis, MO.
Interested? Please email your resume to us and we will promptly follow up with you should you meet the qualifications of this role.



See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Psychiatric Behavioral Health RN

The University Of Kansas Hospital

Posted 3 weeks ago

VIEW JOBS 10/20/2018 12:00:00 AM 2019-01-18T00:00 Position Summary/Career Interest Are you interested in making a positive impact in the lives of children and adolescents? Do you believe in a mission to provide efficient, value added, patient-centered care that are second to none? Do you value excellence, compassion, diversity, integrity, and evidence based decision making? Our growing and innovative Behavioral Health unit is calling for you! As a Behavioral Health RN at our Marillac Campus, you will belong to a team of healthcare professionals who excel in caring for children and youth diagnosed with a mental illness and/or experiencing behavioral challenges. Our Behavioral Health Nurses ensure that our clients receive the best clinical care and patient satisfaction. We provide compassionate and specialized care to each of our patients that come through our doors. The schedules are flexible and weekend premium positions are available. There are lots of growth and development opportunities as our behavioral health units continue to expand. We hope you make the best decision in choosing the #1 Best Hospital in Kansas City to be your home! Responsibilities * Work closely as a partner on the medical staff team to ensure the very best care is given to our patients. * Assess and monitor the administration and documentation of all medications, processing doctor's orders and working closely with the pharmacy. * May conduct assessments and assess for medical emergencies and consult with appropriate staff regarding appropriate treatment. * From time to time, you may facilitate scheduling of medical, dental, and eye appointments and ensure those needs are met. * Ensure all patient charts and related documentation is maintained, current, and relevant at all times. * Oversee the lab clinic. Qualifications * Associates degree or higher in Nursing; BSN preferred or must complete BSN within five years of hire * At least one year of relevant experience * RN License in state of practice with CPR Certification * Certified in behavior management techniques * Knowledge and understanding of physician desk reference guide * Read, write and speak English * Computer literate and proficient in various computer programs * Knowledge of accreditation standards The University Of Kansas Hospital Overland Park KS

Medical Director- Behavioral Health Utilization Review

Expired Job

Newcareers