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Behavioral Health Medical Director – Psychiatrist
Elevance Health. Support behavioral health utilization management activities for Florida Medicaid .
About the role
Key responsibilities & impact- Support behavioral health utilization management activities for Florida Medicaid
- Conduct peer-to-peer discussions with providers
- Perform chart reviews as needed
- Support utilization management and care management teams with clinical expertise
- Participate in clinical rounds and provide psychiatric consultation
- Deliver clinical feedback to external providers and internal staff
- Support clinicians to ensure timely and consistent responses to members and providers
- Provide guidance for clinical operational aspects of a program
- Conduct peer-to-peer clinical reviews with attending physicians and other providers regarding review determinations and patient office visits
- Conduct peer-to-peer clinical appeal case reviews as needed
- Serve as a resource and consultant for other company areas
- Represent the company to external entities and serve on internal or external committees as required
- Chair company committees as needed
- Interpret medical policies and clinical guidelines
- Develop and propose new medical policies based on healthcare changes
- Lead, develop, direct, and implement clinical and non-clinical activities affecting healthcare quality, cost, and outcomes
- Identify and develop innovation opportunities to increase effectiveness and quality
Requirements
What you’ll need- MD or DO required
- Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), where applicable to duties being performed
- Active unrestricted medical license to practice medicine or a health profession in Florida
- Must be located in a state or territory of the United States when conducting utilization review or appeals consideration, unless expressly allowed by law or regulation
- Cannot be located on a US military base, vessel, or embassy when conducting utilization review or appeals consideration
- Minimum of 10 years of clinical experience, or equivalent combination of education and experience
- For Health Solutions and Carelon organizations, including behavioral health, minimum of 5 years of experience providing health care
- Additional experience may be required by State contracts or regulations
- Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted
- Child and Adolescent board certification preferred
- Previous Utilization Management (UM) experience preferred
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work flexibility, except for required in-person training sessions