The primary responsibility of the Behavioral Medical Director is to ensure delivery of cost effective quality care that incorporates recovery, resiliency and person-centered services. Some of the specific responsibilities will include:
Oversee Level of Care guidelines, protocols, reporting and management (along with the Clinical Program Manager) for all utilization review, management and care coordination activities.
Oversight of clinical staff and inpatient hospitalizations, current knowledge of prevalent treatment protocols and philosophies including those that address consumer cultural preferences.
Communicate with all staff related to Ohio operation working on medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews and clinical best practices guideline development.
Must achieve appropriate utilization by performing reviews, denials, peer to peer reviews and consultations, appeals.
Use data to identify opportunities for improvement and implementation of strong action plans for traditional Medicaid enrollees and Medicare â€“ Medicaid enrollees.
Implement a recovery philosophy working closely with the Recovery & Resiliency staff by maintaining a knowledge base in rehabilitation and recovery principles and innovation.
Ensure overall integration of behavioral health services in traditional Medicaid and Medicare â€“ Medicaid enrollee treatment plans.
Provide clinical leadership to behavioral Care Management and Quality staff and supervision to other contracted medical staff that performs behavioral health UM functions for OptumHealth â€“ Ohio.
Periodic supervision/in-service training to both OptumHealth - Ohio clinical staff and other clinical staff focusing on medical necessity, reason(s) for continued inpatient services, state requirements, appropriate psychiatric practice and engagement, empowerment, recovery and rehabilitation.
Promote preventive behavioral health strategies.
Act as liaison to OptumHealth - Ohio service area facilities, physicians, and agencies as requested. Interface with the Community Behavioral Health Center health homes for traditional Medicaid and Medicare-Medicaid enrollees with Serious and Persistent Mental Illness and community partners.
Chair the Quality Management Committee and Utilization Management Committee on a monthly basis.
Provide consultation to Ohio management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and best practices.
Participate in Quality Assurance activities and audits.
Licensed Ohio MD; Board Certified in Psychiatry, required
Sub specialty in child, geriatric or addictions desirable.
Knowledge and understanding of Ohioâ€™s overall behavioral health system required.
Experience in public sector delivery systems and experience in Ohio public sector services preferred.
6 or more years of experience as a practicing psychiatrist required.
3 or more years of supervisory/leadership experience and ability to lead and teach others required.
One or more year experience in managed care conducting Utilization Management activities required.
Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery.
Commitment to assisting people to thrive within the community with maximum independence and self-sufficiency and understanding of the appropriate use of wraparound, stabilization services and community support.
Ability to proactively engage colleagues and manage adversarial situations.
Experience working with community based programs and resources designed to aid the Medicaid population.
Knowledge of post-acute care planning such as home care, discharge planning, case management, and disease management.
PC proficiency, data analysis and strong organizational skills necessary.
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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