Behavioral/Medical Director

JOB SUMMARY:??????????????? The Behavioral Medical Director is responsible for oversight of the overall clinical quality, leadership and direction of the Utilization Management Programs at Health Integrated. The Behavioral Medical Director will help create and manage programs that deliver both quality and value.

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The Health Integrated Behavioral?Medical Director plays a vital role in both the development and implementation of utilization management policy and procedure.? The Behavioral??Medical Director is chosen based upon his/her knowledge of medical practice, experience in Managed Care programs, Utilization Management/Quality Management programs and an ability to direct and interact well with other physicians.

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The Behavioral?Medical Director provides cooperative leadership and direction to the QM/UM (quality management and utilization management) Committee.? The Behavioral??Medical Director is also a member of the Senior Management Committee and Credentialing Committee.

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The Behavioral?Medical Director will be responsible for interfacing with health plans, regarding benefits, administrative issues, and/or medical necessity concerns that cannot be settled at the Director Level or Operational Level.

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The Behavioral?Medical Director takes an active role in the development and promotion of utilization management systems within Health Integrated.? This will include development of utilization management policies and procedures, identifying the type of criteria to be used for authorization and review, and the implementation of a regular forum in which to educate Primary Care Providers (PCP?s) and specialists on utilization management systems.?

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The Behavioral? Medical Director is responsible for the oversight and quality of the physician medical review process, including performing reviews, creating and approving the review process, and operational and quality oversight of contracted physician reviewers and review panels.

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The Behavioral?Medical Director also serves as an important resource and key contact for utilization management nurses for identified case management problems or medical necessity variance concerns.

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MINIMUM QUALIFICATIONS:?

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Education:???????????????????????????? M.D. or D.O. degree, Board Certified in their specialty, Active Medical License without restrictions in two or more states.

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Experience:?????????????????????????? Minimum five years active Behavioral/medical practice experience, minimum three years utilization management and quality management experience, and business experience preferred.

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Knowledge/skills:?????????????? Basic computer literacy required, more advanced desirable.? Current, broad-based expertise in managed care, utilization management and quality management.? Ability to command respect from and interact well with other physicians, nursing staff, management staff and business leaders.? Negotiation and de-escalation skills required.? Business administration skills desirable.