Resp & Qualifications

　　PURPOSE:

　　The Behavioral Health Medical Director oversees all activities of utilization review, care management and quality to determine the medical effectiveness related to behavioral health and substance use. The critical responsibility will be the management of care delivery in a cost effective and quality assured system that will assist the organization to achieve its corporate mission of serving the behavioral health needs of members. Note: We are looking for an experienced professional in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

　　ESSENTIAL FUNCTIONS:

　　Ensure that the provision of behavioral health care service to the membership is compliant with the medical policies and standards. Participate in medical necessity reviews, including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals.

　　The Behavioral Health Medical Director will propose policies and standards for review and resolution to the committee and communicate these policies and standards to physicians participating in the network.

　　Oversees all activities of behavioral health utilization review, care management and quality to determine the medical effectiveness of proposed treatments and approve care management plans.

　　Collaborates with Network Management in improving access to care.

　　Represents company with provider community, professional organizations, legislative work groups and governmental agencies.

　　Responsibility for after-hours function.

　　QUALIFICATIONS:

　　Education: Medical Degree from an accredited medical school, completion of an American residency program.

　　Experience:

　　5 years minimum of clinical practice experience in the field of psychiatry.

　　2 years managed care experience with Accreditation experience.

　　Licenses/Certifications:

　　MD - Physician - State Licensure Maryland Physician License without restrictions.

　　ABPN - American Board of Psychiatry and Neurology Upon Hire Required.

　　Knowledge, Skills, and Abilities (KSAs):

　　Knowledge of managed care concepts and behavioral health care management activities.

　　Skilled in coordinating and collaborating with physicians.

　　Knowledge of patient rights and laws relative to those rights, such as HIPAA.

　　Demonstrated application and knowledge of best behavioral health clinical practices.

　　Knowledge of principles, practices, evidence-based guidelines and standardized processes and procedures for evaluating medical support operations business practices.

　　Salary Range: $219,840 - $408,078

　　Salary Range Disclaimer

　　The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

　　Department

　　Medical Directors

　　Equal Employment Opportunity

　　CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

　　Where To Apply

　　Please visit our website to apply: www.carefirst.com/careers

　　Federal Disc/Physical Demand

　　Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

　　PHYSICAL DEMANDS:

　　The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

　　Sponsorship in US

　　Must be eligible to work in the U.S. without Sponsorship

　　#LI-KL1

　　REQNUMBER: 19284