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Psychiatric Medical Director - Remote California

Company: Magellan Health
Location: San Diego
Posted on: July 1, 2020

Job Description:

Magellan Health offers an incredible amount of freedom for Medical Directors looking to further their career while maintaining a healthy work-life flow. We're known for our strong physician leadership, and our Medical Directors have a seat at the table. This ensures we are focused on so much more than just cost of care; for us, it's about making a difference and having a meaningful impact on as many lives as possible. If you're an inquisitive, solutions-focused and team-oriented professional, then together we can achieve great things. After all, we're dedicated to leading humanity to healthy, vibrant lives. And we know that together, we can make the world a better place.

You will support the clinical vision for the health plan and implements programs to support this vision.


  • You will provide clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight of clinical team members and consultation and training with care managers in order to address cost and quality of care. You will provide day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and medical necessity decisions. You follow high risk cases throughout treatment continuum from inpatient, rehabilitation, partial hospitalization, outpatient and other levels of care. You will ensure that persons with severe, complex, and/or treatment resistant illnesses receive medically necessary coordinated care throughout the episode of treatment. You continue physician oversight of at-risk patients deemed appropriate for complex case management and timely completion of all utilization management activities. You will be involved in the development of case management plans.
  • You will develop and implement a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most cost effective setting. You will evaluate the effectiveness of UM practices and criteria. You will actively monitor for over- and under-utilization. You will assume a leadership position relative to knowledge, implementation, training and supervision of the use of the medical necessity criteria.
  • Along with the Corporate Clinical team, you will implement clinical practice standards and policies developed by Magellan corporate and participates in management of activities. You will develop, implement and interpret medical policy, technology assessments, and medical necessity guidelines.
  • You will develop effective working relationships with practitioners, provider facilities, treatment programs, and may establish relationships and/or consult with client organizations. You will confer directly with psychiatrists and other practitioners regarding the care of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. You will identify and immediately follow up on any quality of care concerns with practitioners and provider facilities and treatment programs involved in the member's care. You will ensure that contract requirements, accreditation standards (e.g. NCQA), state policies and federal policies are implemented specific to each Magellan client. You will work with teams on continuous quality improvement to ensure ongoing compliance in utilization and case management.
  • You will participate in and maintains the integrity of the appeals process, both internally and externally. You are responsible for the investigation of adverse incidents and quality of care concerns. You will participate in preparation for NCQA and URAC certifications. You will develop and provide leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead senior medical director, and quality improvement staff. You may participate in various committees or project teams as directed by the senior medical director or vice-president.

    General Job Information

    TitlePsychiatric Medical Director - Remote CaliforniaGrade34Job FamilyClinical Services GroupCountryUnited States of AmericaFLSA StatusUnited States of America (Exempt)Recruiting Start Date6/15/2020Date Requisition Created6/15/2020Work ExperienceClinicalEducationDO (Required), MD (Required)License and Certifications - RequiredDO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - PhysicianLicense and Certifications - Preferred

    Other Job Requirements

    Responsibilities


    • Managed care experience as a provider and a manager of care.
    • Utilization Review or Physician Advisor experience.
    • Complex case management experience.
    • Accreditation experience (NCQA, AAHCC/URAC).



      • Graduate of an American or Canadian medical school accredited by the Accreditation Council for Medical Education (ACME) or equivalent training in a foreign medical school with successful completion of the ECFMG and FLEX examinations.
      • Full training in a residency program in the United States or Canada that is approved by the Accreditation Council for Graduate Medical Education (ACGME).
      • Minimum of three years involving substantial direct patient care during this period at multiple levels of care.
      • Clinical experience pertinent to the patient population being managed.
      • Unrestricted current and valid license or certification to practice medicine in a state or territory of the United States.
      • Ability and desire to lead through and effect appropriate changes.
      • Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance and continuous quality improvement processes.
      • After Hours coverage may be required.

        Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

Keywords: Magellan Health, San Diego , Psychiatric Medical Director - Remote California, Healthcare , San Diego, California

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