Responsible for behavioral health leadership in the administration of behavioral health services for the health plan including the overall medical policies of the business unit to ensure the appropriate and most cost effective medical care is received and for the benefit of the member.

Works closely with the Health Plan Chief Medical Officer in program development, staff leadership, health care integration and any other activities as needed to improve outcomes, quality measures and appropriate utilization of resources.

**Position located in Louisiana**

Primary duties may include, but are not limited to:

1.Interprets existing policies and assists in developing new policies based on changes in the healthcare or medical arena.

2.Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.

3.Identifies and develops opportunities for innovation to increase effectiveness and quality.

4.Serves as a resource and consultant to other areas of the company, may chair or serve on company committees, may be required to represent us to external entities and/or serve on external committees, conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, provides guidance to staff for clinical operational aspects of the program.

5.Interacts with the physical health medical directors to improve health care quality and provide behavioral health consultation and direction.

6.Supports the medical management staff ensuring timely and consistent responses to members and providers.

7.Interacts with providers, members receiving services, advocate and consumer groups and other MCO behavioral health medical directors in representing the company's philosophy and values.

8.Becomes actively engaged in meetings with the state customer providing oversight for the Managed Medicaid program.

9.Is comfortable with and knowledgeable about NCQA accreditation, specifically HEDIS measures and understands the need to constantly improve these values within health plan to achieve established targets.

10.Understands and uses data analysis for quality improvement, care management and utilization management and in shaping provider behavior.

Qualifications

Requires M.D. or D.O.

Board certification approved by the American Board of Psychiatry and Neurology in Psychiatry.

Must possess an active unrestricted medical license to practice medicine in a state in which the company has an active program.

10 years of clinical experience or any combination of education and experience, which would provide an equivalent background.

SKILLS AND CERTIFICATIONS

Require M.D. or D.O.

Board certification approved by the American Board of Psychiatry and Neurology in Psychiatry.

Must possess an active unrestricted medical license to practice medicine in a state in which the co

10 years of clinical experience

IDEAL CANDIDATE

*Managed care or behavioral health contractor (Magellan) preferred

*General psychiatrist experience, clinical, leadership or practice/clinical setting experience

IDEAL CANDIDATE SHOULD HAVE WORKED FOR THE FOLLOWING COMPANY(IES):

Centene

United

Aetna

Private practices

We would like to find local candidates from Louisiana (New Orleans/Metarie).

We are open to candidates from other states who are willing to relocate and apply for a medical license in Louisiana.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Direct Staffing Inc

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