Sentara
Medical Director-Psychiatrist, Remote Position
Sentara, Virginia Beach, Virginia, us, 23450
City/StateVirginia Beach, FLOverviewWork ShiftFirst (Days) (United States of America)Sentara Health Plan (SHP) Medical Director Job DescriptionThe Behavioral Health (BH) Medical Director provides clinical oversight and management of SHP activities including, case management, utilization management, quality management, and contracted services.
This is a Remote position for a candidate who resides in one of the following US states; VA, NC, MD, FL, NV, WY, SD, WA, IN, TN, GA, SC, TX, WV, WI.Responsibilities:Develops and implements medical policies for Behavioral Health.Ensures the appropriate and timely use of criteria and guidelines in the administration of behavioral health treatment.Provides utilization review, quality management, case management, BH education, appeals and grievance activities.Directs appropriate utilization of inpatient and outpatient behavioral health services utilizing clinical knowledge, experience and applicable medical necessity policies.Participates in medical director, case management and utilization management rounds.Partakes in behavioral health committees and clinical practice guidelines review.Engages in medical staff education and process improvement activities.Collaborates with medical staff to manage complex or difficult cases and service authorizations.Composes clear and concise clinical rationales for members and provider determination notifications.Conducts Peer-to-Peer consultation as needed during review process or upon request of the requesting physician.Performs quality of care reviews.Other duties and goals assigned by the medical director's supervisor.Required Qualifications:MD or DO degree from an accredited medical school.At least 5 to 7 years clinical experience after the completion of residency training program.Current, valid, unrestricted Virginia Medical License.Board certification in Psychiatry.Preferred Qualifications:Experience in Utilization and Case Management.Knowledge of rules regulations, policies, and standards related to managed care.Experience working with the Medicaid population.Clinical experience working with adults and pediatrics.Job Summary:The Medical Director is responsible for providing clinical leadership within Sentara Health Plans, aligned to one or more plans. Accountable for monitoring utilization, case management and quality outcomes. The Medical Director collaborates with the Sentara Health Plans Chief Medical Director, Senior Medical Director(s) and Clinical Care Services (CCS) teams to establish, implement, and evaluate effectiveness of clinical programs to support members and meet the department goals. Medical Director activities further include support of the CCS nurses, Government services nurses, Pharmacy staff, Population Health and Quality Improvement Teams. Lastly, Medical Directors interact externally with network physicians, vended program clinical leaders, and government program leaders as required to improve the quality of clinical outcomes, cost efficiency and patient/member experience with the Health Plan and Health Systems with which we contract.Qualifications:MD - Doctor of Medicine (Required)Board certification required. Master's level degree in Medical Management, Business Administration or Public Health preferred. Medicaid, including long term services and support, and/or Medicare, including D-SNP, experience preferred.Skills:Active LearningActive ListeningCommunicationComplex Problem SolvingCoordinationCritical ThinkingJudgment and Decision MakingLeadershipLearning StrategiesMathematicsManagement of Financial ResourcesManagement of Material ResourcesManagement of Staff ResourcesMicrosoft ExcelMicrosoft WordMonitoringPersuasionProject ManagementQuality Control AnalysisReading ComprehensionScienceService OrientationSocial PerceptivenessSpeakingSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.In support of our mission "to improve health every day," this is a tobacco-free environment.
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This is a Remote position for a candidate who resides in one of the following US states; VA, NC, MD, FL, NV, WY, SD, WA, IN, TN, GA, SC, TX, WV, WI.Responsibilities:Develops and implements medical policies for Behavioral Health.Ensures the appropriate and timely use of criteria and guidelines in the administration of behavioral health treatment.Provides utilization review, quality management, case management, BH education, appeals and grievance activities.Directs appropriate utilization of inpatient and outpatient behavioral health services utilizing clinical knowledge, experience and applicable medical necessity policies.Participates in medical director, case management and utilization management rounds.Partakes in behavioral health committees and clinical practice guidelines review.Engages in medical staff education and process improvement activities.Collaborates with medical staff to manage complex or difficult cases and service authorizations.Composes clear and concise clinical rationales for members and provider determination notifications.Conducts Peer-to-Peer consultation as needed during review process or upon request of the requesting physician.Performs quality of care reviews.Other duties and goals assigned by the medical director's supervisor.Required Qualifications:MD or DO degree from an accredited medical school.At least 5 to 7 years clinical experience after the completion of residency training program.Current, valid, unrestricted Virginia Medical License.Board certification in Psychiatry.Preferred Qualifications:Experience in Utilization and Case Management.Knowledge of rules regulations, policies, and standards related to managed care.Experience working with the Medicaid population.Clinical experience working with adults and pediatrics.Job Summary:The Medical Director is responsible for providing clinical leadership within Sentara Health Plans, aligned to one or more plans. Accountable for monitoring utilization, case management and quality outcomes. The Medical Director collaborates with the Sentara Health Plans Chief Medical Director, Senior Medical Director(s) and Clinical Care Services (CCS) teams to establish, implement, and evaluate effectiveness of clinical programs to support members and meet the department goals. Medical Director activities further include support of the CCS nurses, Government services nurses, Pharmacy staff, Population Health and Quality Improvement Teams. Lastly, Medical Directors interact externally with network physicians, vended program clinical leaders, and government program leaders as required to improve the quality of clinical outcomes, cost efficiency and patient/member experience with the Health Plan and Health Systems with which we contract.Qualifications:MD - Doctor of Medicine (Required)Board certification required. Master's level degree in Medical Management, Business Administration or Public Health preferred. Medicaid, including long term services and support, and/or Medicare, including D-SNP, experience preferred.Skills:Active LearningActive ListeningCommunicationComplex Problem SolvingCoordinationCritical ThinkingJudgment and Decision MakingLeadershipLearning StrategiesMathematicsManagement of Financial ResourcesManagement of Material ResourcesManagement of Staff ResourcesMicrosoft ExcelMicrosoft WordMonitoringPersuasionProject ManagementQuality Control AnalysisReading ComprehensionScienceService OrientationSocial PerceptivenessSpeakingSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.In support of our mission "to improve health every day," this is a tobacco-free environment.
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