Psychiatric-Mental Health opening in Upper Darby, Pennsylvania. Regional Medical Director Provider (Delaware County, Part-Time)
BC / BE Psychiatrist to fulfill the role of Regional Medical Director and offer administrative services in our Delaware County Office. The Regional Medical Director is responsible for assuring the quality and efficiency of the health care delivered to Community Care members. This includes significant responsibility for quality management and utilization management and for assuring the adequacy of the provider network for the clinical needs of Community Care members. The Medical Director also participates in regional leadership policy decisions and strategic planning. In addition, the Regional Medical Director is a resource to participating providers in the provision of quality medical care. This psychiatrist would report to the Senior Medical Director and provide clinical and medical supervision to the care management and quality management staff in our office in Delaware County, Pennsylvania.
Community Care is a public behavioral health managed care organization (BH-MCO) that is part of the UPMC Insurance Division that is both NCQA and URAC accredited. Duties could be individualized and be offered within a weekly time frame of 20 hours. This will be a hybrid position with sometime in the office as needed and remote work. There are no requirements for on-call, weekend, or evening hours.
The Regional Medical Director would join a highly educated, collegial and motivated team of physician advisors who advocate well for the recovery from mental health and substance use disorders for nearly a million individuals across Pennsylvania. He or she would have the opportunity to be involved in many of the new initiatives that include targeting enhanced service delivery for specific populations, physical health/ behavioral health integration, substance use treatment, residential treatment for children, prescribing trends; some of which could result in presentations and or journal publication.
Child and adolescent psychiatrists, adult psychiatrists as well as psychiatrists with additional subspecialty training are welcome to apply.
- Acts as a liaison for Community Care with community physicians, hospital staff, and other professionals and agencies with regard to psychiatric services.
- Acts as a physician reviewer for cases referred by care management staff.
- Advises the Regional Director on the development and review of programs, positions, and budgets having an impact on clinical services.
- Assures effective and appropriate utilization of the various levels of care in the provider network.
- Assures psychiatric involvement in the development, approval, and review of all policies, procedures, and protocols governing clinical care.
- Assures the quality of treatment and related services provided by Community Care professional staff, through participation (directly or by designee) in the ongoing quality management and audit processes.
- Develops and maintains effective relationships with providers.
- Ensures prompt and fair resolution of care management decision appeals.
- Ensures the quality of clinical care provided to Community Care members
- Implements quality management programs and continuing education activities.
- Interfaces with the Counties and DHS as indicated.
- Interfaces with the Physical Health MCO's through Medical Director to Medical Director meetings, and participates in the appropriate committees of physical health MCO's where applicable, such as a pharmacy and therapeutics committee
- Meets or exceeds NCQA, URAC or other regulatory standards
- Reviews of complaints and grievances in accordance with Community Care procedures, and to assure prompt response and action at all stages of the complaint and grievance process.
- Reviews proposed service denials and supervises care managers in the utilization of appropriate medical necessity criteria, and ensures appropriate care management integration and coordination.
- Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System.
- Supports member satisfaction with the care management process
- Supports provider satisfaction with the care management process.
- Works closely with the medical directors of physical health MCO's to assure coordination between physical health and behavioral health needs and services.
- Works with Provider Relations to enhance the working relationship between Community Care and the providers in its network.
- Works with Quality Management in designing and evaluating protocols.
- Minimum 10 years clinical experience.
- Doctor of Medicine or Doctor of Osteopathy from an accredited school. Unrestricted License in Pennsylvania.
- Post residency clinical experience
- At least 5 years of management experience preferred.
- Experience in managed care setting preferred
- Ability to implement medical policies, and to enforce those policies through appropriate action.
- Ability to maintain effective professional liaison with all levels of executive and medical staff, including professional and institutional providers of care.
- Ability to implement programs of quality care analysis, peer review, and professional education.
- Quality of clinical care provided to COMMUNITY CARE members.
- Effective and appropriate utilization of the various levels of care in the provider network.
- Member satisfaction with the care management process.
- Provider satisfaction with the care management process.
- Meeting or exceeding NCQA standards and other applicable benchmarks.
- Prompt and fair resolution of care management decision appeals.
- Development and maintenance of effective relationships with providers
Licensure, Certifications, and Clearances:
- Act 34 Criminal Clearance
- MD or DO