This job is archived
Associate Medical Director
Tampa, Florida, United States
Job Summary
Occupation
Physician
Specialty
Psychiatric-Mental Health
Degree Required
MD/DO
Position Type
Permanent/Full-Time
Work Environment
Ambulatory Surgery Center (ASC)
Academic/Training Program
Hospital
Clinic/Private Practice
Location
San Diego, California, United States
Visa Sponsorship
No
Job Description
Last Update:
7/22/14
Job Summary
Along with the Care Management Center Medical Director and Clinical Officer, the Associate Medical Director defines the clinical vision of the CMC and implements programs to support this vision.
Essential Functions
•Provides psychiatric leadership to an assigned interdisciplinary UM team, which includes clinical/medical oversight of clinical team members and consultation and training with care managers. Provides day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the management of high-risk cases and medical necessity decisions. Follows high risk cases throughout treatment at the inpatient and partial hospitalization levels of care. Continues physician oversight of high risk patients deemed appropriate for Intensive Care Management. Ensures that patients with severe, complex, and/or treatment resistant illnesses receive coordinated care throughout the episode of treatment, including extended outpatient care to the extent it is medically necessary.
•Develops and implements a utilization management (UM) 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 effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position relative to knowledge, implementation, training and supervision of the use of the Criteria for Medical Necessity in use in the CMC.
•Along with the Corporate Clinical team, implements clinical practice standards developed by Magellan corporate and participates in management of activities. Develops implements and interprets Magellan medical policy for the CMC (including Medical Necessity Criteria, Clinical Practice Guidelines and New Technology Assessments).
•Develops effective working relationships with practitioners and provider facilities and treatment programs. Confers directly with psychiatrists and other practitioners regarding the care of patients with severe, complex, and/or treatment resistant illnesses. Identifies and immediately follows up any quality of care concerns with practitioners and provider facilities and treatment programs involved in the member’s care.
•Participates in and maintains the integrity of the appeals process, both internally and externally to the CMC. Assumes responsibility for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. 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.
Non-Essential Functions
Ensures that providers are treated with respect through every aspect of the managed care process. Participates in CMC regular Quality Improvement meeting structure. Develops a collegial relationship with health plan medical directors. Participates as a member of the CMC PPRC and Clinical Review Group. Participates as a member of the CMC Practitioner Advisory Group. Works with medical director to assume responsibility for PPRC and PAG, and MAG or equivalent committees. Ensures that the utilization management process is user friendly to all its stakeholders. Develops a partnership relationship with the clinical team leader, supporting his/her efforts to train and supervise the Care Managers in the utilization management team.
Minimum Requirements
Education: MD
Field(s) of study: 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 ACGME.
Experience: 5-8 years
Job Specific: Post-residency experience of at least five years involving substantial direct patient care during this period at multiple levels of care.
Other
Familiarity with current research and use of psychopharmacologic and psychotherapeutic modalities of treatment. Clinical experience pertinent to the patient population(s) being managed.
Licenses, Certifications, etc.: Must hold current, active license to practice medicine in the United States. Licensure must be for independent practice and be unencumbered by sanctions, practice restrictions or other disciplinary actions
Must hold licensure or be license eligible in state of operation. Licensure must be complete within the 1st year of employment. In addition, hold an active license to practice medicine in the state where required to conduct utilization review activities, if required for the position.
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).
Preferred Qualifications
Experience: Managed care experience preferred, as a provider and a manager of care. Utilization Review or Physician Advisor experience preferred. Accreditation experience (NCQA, AAHCC/URAC) preferred.
Along with the Care Management Center Medical Director and Clinical Officer, the Associate Medical Director defines the clinical vision of the CMC and implements programs to support this vision.
Essential Functions
•Provides psychiatric leadership to an assigned interdisciplinary UM team, which includes clinical/medical oversight of clinical team members and consultation and training with care managers. Provides day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the management of high-risk cases and medical necessity decisions. Follows high risk cases throughout treatment at the inpatient and partial hospitalization levels of care. Continues physician oversight of high risk patients deemed appropriate for Intensive Care Management. Ensures that patients with severe, complex, and/or treatment resistant illnesses receive coordinated care throughout the episode of treatment, including extended outpatient care to the extent it is medically necessary.
•Develops and implements a utilization management (UM) 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 effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position relative to knowledge, implementation, training and supervision of the use of the Criteria for Medical Necessity in use in the CMC.
•Along with the Corporate Clinical team, implements clinical practice standards developed by Magellan corporate and participates in management of activities. Develops implements and interprets Magellan medical policy for the CMC (including Medical Necessity Criteria, Clinical Practice Guidelines and New Technology Assessments).
•Develops effective working relationships with practitioners and provider facilities and treatment programs. Confers directly with psychiatrists and other practitioners regarding the care of patients with severe, complex, and/or treatment resistant illnesses. Identifies and immediately follows up any quality of care concerns with practitioners and provider facilities and treatment programs involved in the member’s care.
•Participates in and maintains the integrity of the appeals process, both internally and externally to the CMC. Assumes responsibility for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. 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.
Non-Essential Functions
Ensures that providers are treated with respect through every aspect of the managed care process. Participates in CMC regular Quality Improvement meeting structure. Develops a collegial relationship with health plan medical directors. Participates as a member of the CMC PPRC and Clinical Review Group. Participates as a member of the CMC Practitioner Advisory Group. Works with medical director to assume responsibility for PPRC and PAG, and MAG or equivalent committees. Ensures that the utilization management process is user friendly to all its stakeholders. Develops a partnership relationship with the clinical team leader, supporting his/her efforts to train and supervise the Care Managers in the utilization management team.
Minimum Requirements
Education: MD
Field(s) of study: 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 ACGME.
Experience: 5-8 years
Job Specific: Post-residency experience of at least five years involving substantial direct patient care during this period at multiple levels of care.
Other
Familiarity with current research and use of psychopharmacologic and psychotherapeutic modalities of treatment. Clinical experience pertinent to the patient population(s) being managed.
Licenses, Certifications, etc.: Must hold current, active license to practice medicine in the United States. Licensure must be for independent practice and be unencumbered by sanctions, practice restrictions or other disciplinary actions
Must hold licensure or be license eligible in state of operation. Licensure must be complete within the 1st year of employment. In addition, hold an active license to practice medicine in the state where required to conduct utilization review activities, if required for the position.
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).
Preferred Qualifications
Experience: Managed care experience preferred, as a provider and a manager of care. Utilization Review or Physician Advisor experience preferred. Accreditation experience (NCQA, AAHCC/URAC) preferred.