Senior Medical Director - Psychiatry | Magellan Health Miami, Florida

Job Details:
ESSENTIAL FUNCTIONS:
- Directs the utilization review process and oversees the quality of behavioral health utilization determinations. Develops and implements the behavioral health utilization management program. Responsible for training and oversight of the associate medical director, and for physician advisor training and monitoring which includes orientation, training, supervision, chart auditing, meetings scheduling and oversight of invoices.
-Responsible to implement behavioral Health medical policy, technology assessment and clinical practice standards developed by Magellan corporate and participates in management of the inter-rater reliability process to ensure consistency between reviewers. Provides input regarding the need for modifications and additions to medical policy. May participate on corporate medical policy and clinical guideline committees.
- Ensures compliance with care management program and clinical goals through regular monitoring of care management center performance. Evaluate the effectiveness of the clinical program and modify programs as needed to achieve desired results.
-Develops the Behavioral Health Medical Action Plan (MAP) which includes metrics for utilization and quality management. Develops mitigating strategies to ensure goals are met or exceeded. Works closely with the clinical care management to ensure effective staff case review.
- Provides psychiatric leadership, oversight, and consultation for Quality Improvement (QI) Program and the Utilization Management (UM) Programs including: monitoring effectiveness and compliance with goals, prevention programs, network development and management, quality of care concerns and adverse incidents, medical practice of network or sub-capitated providers, clinical service delivery system, coordination with After Hours Team and oversight of clinical appeals.
-Works collaboratively with QI on the development and implementation of QI activities, UM and QI program descriptions, evaluations, and work plans. Chairs the Regional Network Credentialing Committee (RNCC), and the CMC Quality Improvement Committee (QIC). Develops and provides psychiatric leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.
-Works closely w the network management team on an integrated clinical-network approach
- Recruit, train, supervise, mentor, oversee and evaluate the quality of medical staff and physician advisors. Ensures adequate physician resources. Developd and manages the physician budget to include physician advisors and Associate Medical Directors. Provides oversight and training for the Associate Medical Director if applicable.
The medical director provides an interface to key health...
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