BlueCross BlueShield of Western New York

About BlueCross BlueShield of Western New York

 

Job Category:

Healthcare/Pharmacy

Country:

United States

Postal Code:

31701

Approximate Salary:

Not Specified

Position Type:

Part Time

This job has expired and you can't apply for it anymore. Start a new search.

Medical Director Behavioral Health

Posted: 08/31/2018

Auto req ID 1959BR Company BlueCross BlueShield of WNY About Us BlueCross BlueShield of Western New York is a division of HealthNow New York Inc., one of New York’s leading health care companies that provides access to quality health care and solutions for members throughout Upstate New York. Since 1936, BlueCross BlueShield has helped millions of people gain access to health care. Headquartered in Buffalo, NY, the company is an independent Licensee of the BlueCross BlueShield Association. As the region’s leading health plan, serving over 800,000 members, BlueCross BlueShield believes in taking small steps towards healthier living. You can visit our website at www.bcbswny.com. Title Medical Director Behavioral Health Position Posting Location Albany/Buffalo
Buffalo
Status Part Time Temporary or Per Diem Hours 8:00 to 4:40 Job Description This position is responsible for ensuring that high quality, cost effective and appropriate mental health and substance use disorder health care is delivered by qualified plan providers to members, according to product or benefit design. Maintains open communication with other Medical Directors, Medical Societies, Peer Groups, CMS, and DOH.Performs educational outreach and responds to provider concerns or inquiries. Acts as a Behavioral Health resource for staff members throughout the organization. Primary Responsibility Ensures overall Behavioral Health program integrity through claim review and associated documentation to assure services are appropriate. Provides clinical expertise and judgment to effectively focus on areas of misuse as well as potential fraud and abuse. Performs educational outreach; responds to provider concerns or inquiries, interacts with staff from various regulatory agencies, medical/specialty societies and peer groups. Oversees internal Behavioral Health review guidelines to ensure compliance with regulatory requirements. Acts as a resource for staff members and serves as Behavioral Health clinical lead to medical policy development process. Actively participates in the Quality Improvement Process and departmental quality initiatives through auditing responsibilities, departmental corrective action team projects, and the open sharing of thoughts and ideas for improving work processes related to Behavioral Health. Responsible for physician review and oversight of all potential adverse determinations (for all lines of business) including precertification/prior authorization, concurrent review and retrospective audits. Coordinates the responses needed to address regulatory and accreditation concerns pertaining to medical management issues. Advises on policies and procedures relating to the Behavioral Health program, including those needed to meet regulatory, accrediting and other oversight organizations. Participates on Corporate Medical Policy committee. Participates in the provider evaluation and education. Researches and evaluates current and new Behavioral Health policies in keeping with regional, corporate and association guidelines. Fosters positive relations within the regional medical and Behavioral Health community, interacting with hospitals, physicians, and other providers. Provides Behavioral Health leadership in the coordination of medical management linkages with participation and non-participating hospitals, facilities, vendors, MCO's, etc. Actively participates in leadership/management activities to help identify internal and external challenges and opportunities, contributes to sound organizational strategies and actions, and provides insight, feedback and counsel to other members of the management team. Serves as chairperson or leader of assigned clinical or quality committees, or in the administrative management of the medical director staff. At the direction of the Senior Medical Director of CMO engages in external activities or initiatives which are important to HealthNow's community leadership role and may include oversite or participation in work groups, leadership forums, and not-for-profit board positions. Knowledge and Skills Must be licensed to practice medicine in New York State without restriction, board certification is required (psychiatric/chemical dependency) and a minimum of ten years of experience in a clinical setting. Experience in medical utilization review practices, medical and administrative policy and procedure development and medical management strongly preferred. Must possess superior interpersonal, presentation and communication, analytic and negotiating abilities. Knowledge of managed care principles including utilization review procedures, risk management, network management, and provider profiling is desirable. Strong leadership qualities and the ability to interface with personnel at all levels of the corporation as well as members of various medical societies and government representatives as required. The incumbent must keep abreast of medical practice and technology changes that may result in improper medical service requests, billing or program abuse. This is accomplished through continuing education opportunities and certification requirements. Experience Must be licensed to practice medicine in New York State without restriction, board certification is required (preferably in Behavioral Health) and a minimum of ten years of experience in a clinical setting. Experience in medical utilization review practices, medical and administrative policy and procedure development and medical management strongly preferred. Education Required Education:MD-Doctor of Medicine (N/A) License Medical Doctor Working Conditions Must be able to work in an office environment Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc) Removal Date 06-Dec-2018

Apply Now
This job has expired and you can't apply for it anymore