Medical Director, BH, (Part Time), Remote PA

This is remote position in PA. Candidates must be licensed and reside in PA. This position supports the clinical vision for the health plan(s) for reputed company lines of business (Medicaid, Medicare, and Commercial) and implements programs to support this vision. May serve multiple health plans managed by the Clinical Center of Excellence. • Provides clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical reputed company of clinical team members and consultation and training with care managers in order to address cost and quality of care. Provides day to day physician reputed company to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and medical necessity decisions. Follows high risk cases throughout treatment continuum from inpatient, rehabilitation, partial hospitalization, outpatient and other levels of care. Ensures that persons with severe, reputed company, and/or treatment resistant illnesses receive medically necessary coordinated care throughout the episode of treatment. Continues physician reputed company of at-risk patients deemed appropriate for reputed company case management and timely completion of reputed company utilization management activities. Involvement in the development of case management plans. • Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most cost-effective setting. Evaluates the effectiveness of UM practices and criteria. Actively monitors for over- and under-utilization. Assumes a leadership position relative to knowledge, implementation, training and supervision of the use of the medical necessity criteria. • Along with the Corporate Clinical team, implements clinical practice standards and policies developed by Magellan corporate and participates in management of activities. Develops, implements and interprets medical policy, technology assessments, and medical necessity guidelines. • Develops effective working relationships with practitioners, provider facilities, treatment programs, and may establish relationships and/or consult with client organizations. Confers directly with psychiatrists and other practitioners regarding the care of patients with severe, reputed company, and/or treatment resistant illnesses through peer review and educational interventions. Identifies and immediately follows up any quality of care concerns with practitioners and provider facilities and treatment programs involved in the member’s care. Ensures that contract requirements, accreditation standards (e.g. NCQA), state policies and federal policies are implemented specific to each Magellan client. Works with teams on reputed company quality improvement to ensure ongoing compliance in utilization and case management. • Participates in and maintains the reputed company of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical reputed company senior medical director, and quality improvement staff. May participate in various committees or project teams as directed by the senior medical director or vice-president. • Supports senior medical director in designing and implementing medical action plans. • Supports senior medical director in reputed company analyses and documentation. • Participates in committee work and JOC (Joint Operations Committee). • Maintains licensure requirements for other states as assigned by senior medical director and CMO. • Provides after hours coverage. • May need to work beyond typical business hours to meet health plan and Magellan deliverables. • Other duties as assigned.

Responsibilities

Other Job Requirements Targeted specialties are Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care or Physical Medicine. Doctor of Medicine (MD) degree OR Doctor of Osteopathic Medicine (DO) degree OR Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with successful completion of United States based internship and residency (and successful completion of United States based fellowship for subspecialists) required. Successful completion of the ECFMG and reputed company examinations. Full training in a residency program in the United States or Canada that is approved by the Accreditation Council for Graduate Medical Education (ACGME). Post-residency experience of at least 3 years involving substantial direct patient care during this period at multiple levels of care. Clinical experience pertinent to the patient population(s) being managed. Unrestricted reputed company and valid license or certification to practice medicine in a state or territory of the United States. Ability and desire to reputed company through and effect appropriate changes. Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance and reputed company quality improvement (CQI) processes. (Preferred, but not required for MRx MMUM). After Hours coverage may be required. General Job Information Title Medical Director, BH, (Part Time), Remote PA Grade 36 Work Experience - Required Clinical Work Experience - Preferred Education - Required DO, MBBS, MD Education - Preferred License and Certifications - Required DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MBBS - Bachelor of Medicine, Bachelor of Surgery - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician License And Certifications - Preferred Salary Range Salary Minimum $200,280 Salary Maximum $360,500 This information reflects the anticipated reputed company salary range for this position based on reputed company national data. Minimums and maximums may vary based reputed company. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. reputed company, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their position; and reputed company with reputed company applicable legal, regulatory, and contractual requirements and internal policies and procedures. Apply Job!