Medical Director -Psychiatry- California
Company: Magellan Health
Location: San Diego
Posted on: July 21, 2021
This position supports the clinical vision for the health
plan(s) and implements programs to support this vision. May serve
multiple health plans managed by the Clinical Center of
- Provides 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. Provides 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. Follows high risk
cases throughout treatment continuum from inpatient,
rehabilitation, partial hospitalization, outpatient and other
levels of care. Ensures that persons with severe, complex, and/or
treatment resistant illnesses receive medically necessary
coordinated care throughout the episode of treatment.
Continues physician oversight of at-risk patients deemed
appropriate for complex case management and timely completion of
all utilization management activities. Involvement in the
development of case management plans.
- Develops and implements 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. Evaluates the
effectiveness of UM practices and criteria. Actively monitors for
over- and under-utilization. Assumes a leadership position relative
to knowledge, implementation, training and supervision of the use
of the medical necessity criteria.
- Along with the Corporate Clinical team, implements clinical
practice standards and policies developed by Magellan corporate and
participates in management of activities. Develops, implements and
interprets medical policy, technology assessments, and medical
- Develops effective working relationships with practitioners,
provider facilities, treatment programs, and may establish
relationships and/or consult with client organizations. Confers
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.
Identifies and immediately follows up any quality of care concerns
with practitioners and provider facilities and treatment programs
involved in the member’s care. Ensures that contract
requirements, accreditation standards (e.g. NCQA), state policies
and federal policies are implemented specific to each Magellan
client. Works with teams on continuous quality improvement to
ensure ongoing compliance in utilization and case
- Participates in and maintains the integrity of the appeals
process, both internally and externally. Responsible for the
investigation of adverse incidents and quality of care concerns.
Participates in preparation for NCQA and URAC certifications.
Develops and provides leadership for NCQA-compliant clinical
quality improvement activity (QIA) in collaboration with the
clinical lead senior medical director, and quality improvement
staff. May participate in various committees or project teams
as directed by the senior medical director or vice-president.
- Other duties as assigned.
- 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).
- Post-residency experience of at least 5 years involving
substantial direct patient care during this period at multiple
levels of care.
- Clinical experience pertinent to the patient population(s)
- Must be board-certified in a medical specialty by the American
Board of Medical Specialties (ABMS) or by a specialty affiliate of
the American Osteopathic Association (AOA).
- Unrestricted current and valid license or certification to
practice medicine in a state or territory of the United
- Targeted specialties are Primary Care, Geriatrics, Palliative
Care or Physical Medicine.
- Managed care experience, as a provider and a manager of care.
Utilization Review experience. Accreditation experience (NCQA,
Medical Director -Psychiatry- California
Certifications - Required
DO - Physician, State Licensure and Board Certified (ABMS or
Specialty Board) - Physician, MD - Physician, State Licensure and
Board Certified (ABMS or Specialty Board) - Physician
Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the
security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and
contractual requirements and internal policies and procedures.
Keywords: Magellan Health, San Diego , Medical Director -Psychiatry- California, Other , San Diego, California
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