UNITEDHEALTH GROUP
Published
July 8, 2021
Location
Telecommute
Category
Job Type
Work Setting
Remote / Home-based

Description

The primary responsibility for the Senior Behavioral Medical Director is ensuring the delivery of cost-effective quality care that incorporates recovery, resiliency and person-centered services.  Responsible for Level of Care guidelines and utilization management protocols. Responsible for oversight and management with the Clinical Director and Clinical Program Director all utilization review, management and care coordination activities.  The Medical Director will provide clinical oversight to the clinical staff, oversee the provision of both inpatient and outpatient services; and keep current regarding prevalent treatment protocols and philosophies including those that address consumer cultural preferences. Responsible for maintaining the clinical integrity of the program, including concurrent reviews of outpatient services; providing oversight to utilization management and quality staff; providing consultation to providers and other community-based clinicians, including general practitioners.  Will provide timely psychiatric services for the behavioral health operation including communication with the Health Plan Medical Director, clinical and quality staff, medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews, and clinical best practices guideline development.

If you are located in New York, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Responsible for achieving appropriate utilization by performing reviews, denials, peer reviews and appeals; consulting with care management staff; using data to identify opportunities for improvement and implementing strong action plans for both Medicaid enrollees
  • Responsible for implementing a recovery philosophy working closely with the Recovery & Resiliency staff by maintaining a knowledge base in rehabilitation and recovery principles and innovations; modeling principles of engagement, empowerment and learning with colleagues and employees, and training all staff in the practical implications of these principles with a particular emphasis on care management, alternative levels of care and network sufficiency
  • Provide clinical leadership and supervision to other contracted medical staff that may perform behavioral health UM functions for Optum
  • Provide periodic supervision/in-service training to both Optum clinical staff and other staff as needed focusing on medical necessity, reason(s) for continued services, state requirements, appropriate psychiatric practice and engagement, empowerment, recovery and rehabilitation
  • Ensure systematic screening for behavioral health related disorders by using standardized and/or evidence-based approaches
  • Provide peer to peer reviews and consultations
  • Act as a liaison with Health Plan, New York State and Optum service area facilities, physicians, and agencies as requested
  • Act as a liaison with Community & State and Optum service area facilities, physicians, and agencies as requested
  • Chair the Quality Management Committee and Utilization Management Committee as required as well as participate in the NY Regional Planning Committee
  • Complete all medical necessity reviews when Care Managers are unable to authorize continuation of services
  • Provide sufficient electronic documentation in the consumer record when a denial is made for either adult or child / adolescent
  • Establish criteria and procedures for the Medical Director Review of clinical cases
  • Provide consultation to Optum management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and best practices
  • Conduct clinical reviews of contracted provider clinical records as requested
  • Requires in-person attendance at the weekly NY HP Senior Team meetings and monthly NY state MD meetings

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • New York Licensed physician
  • Board Certified in Psychiatry
  • 5+ years of experience as a psychiatrist working in a clinical setting
  • 3+ years of managed care experience
  • Knowledge and understanding of New York's overall behavioral health system
  • Foundational level skills in MS Word, Excel and Outlook
  • Local to the NYC area
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