Psychiatric Medical Director - Remote California
Company: Magellan Health
Location: San Diego
Posted on: July 1, 2020
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
- 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
- Managed care experience as a provider and a manager of
- 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
- Unrestricted current and valid license or certification to
practice medicine in a state or territory of the United
- Ability and desire to lead through and effect appropriate
- Experience with cost-benefit analysis, medical decision
analysis, credentialing, quality assurance and continuous quality
- 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
Keywords: Magellan Health, San Diego , Psychiatric Medical Director - Remote California, Healthcare , San Diego, California
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