Associate Behavioral Health Medical Director

Job description

Job Summary: The Associate Medical Director, Behavioral Health supports staff by providing training, clinical consultation, and clinical case reviews members. Essential Functions: - Participate in peer-to-peer discussions - Provide provider education, training, data sharing, performance evaluations and orientation to the plan - Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns - Participate in development of policies and procedures - Provide cross-coverage for other Medical Directors and/or markets, as needed - Provide prior authorization medical reviews, consultation and clinical review services - Conduct clinical reviews for designated CareSource members - Conduct Clinical Appeals - Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs - Perform any other job related instructions, as requested Education and Experience: - Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required - Successful completion of a residency training program in psychiatry is required - Minimum of three (3) years of...