Mangrum

Psychiatrist Medical Director- Utilization Review

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  • Burr Ridge, IL, USA
  • 2021-11-13

Psychiatrist

Location: Chicago, IL

Job description:

You could be the one who changes everything for our 25 million members. Our Client is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. 

Position Purpose: 

This position shall be responsible for all Behavioral Health activities. This position shall be actively involved in all major clinical program components of YouthCare, including review of behavioral health care provided, clinical professional aspects of YouthCare contracts, and other areas of responsibility as may be designated by Contractor.

Monitors all clinical aspects of behavioral health, and helps establish policy and procedures for behavioral health, including its integration with medical care and pharmacy. Serves as a key representative and spokesperson with respect to the external behavioral health community in the market. Performs initial psychiatric assessments, develops individualized treatment plans, and implements treatment for members. 

Essential Functions:

  • Provides clinical oversight in behavioral health for the assigned market. Monitors all clinical aspects of behavioral health, including care and utilization management quality improvement, individual health plans, administering care and overall administration including legal and finance.
  • Responsible for working within and promoting an integration of behavioral health into all functional areas of the health plan and working collaboratively with corporate behavioral health and medical staff to implement integrated policies and procedures. Provides assistance to the market medical director and clinical staff to assure effective integration of behavioral services into health plan medical management activities.
  • Develops treatment care plans by determining nature and extent of cognitive, emotional, developmental, social, and behavioral disorders; establishing treatment goals and methodologies.
  • Provides care to members by utilizing psychotherapeutic methods and medications, discussing progress toward goals with members, providing instructions, monitoring effect of medications and supervising staff provision of services.
  • Maintains interdisciplinary treatment by reviewing treatment care plans and progress, consulting and collaborating with primary care physicians, psychiatrists, mental health therapists, nurses, and other health care providers
  • Works closely with the market’s behavioral health medical director to assure clinical compliance with all company, customer and regulatory requirements for behavioral services.
  • Assists in establishing policy and procedures for behavioral health, including its integration with medical care and pharmacy.
  • Assists in the continuously improving of the delivery of care system in the assigned market, including working collaboratively with providers to encourage development of new and innovative types of care and better integrating BH with physical health and social services.
  • In concert with the market’s behavioral health medical director, provides leadership, oversight and guidance of behavioral health operations in Health Services clinical management. Ensures that activities are carried out in a timely manner.
  • Works with the market behavioral health medical director to assist in the development and maintenance of a strong, quality network of providers.
  • Helps establish policy and procedures for behavioral health, including its integration with medical care and pharmacy. This person will provide teaching, training, coaching, and supervision of internal staff.
  • Develops and manages activities to ensure compliance with Federal, State, and NCQA accreditation standards
  • Participates in the identification and analysis of medical information from multiple sources in order to develop interventions to improve quality of care and outcomes.
  • Makes recommendations (based on daily activities of evaluating members’ care) about medical policy, clinical criteria and administrative process.

Education/Experience

  • Board-certified, Illinois-licensed psychiatrist with a minimum of eight (8) years of experience in mental health, substance use, or children services
  • Experience with child welfare system and trauma informed practices

Preferred Experience:

  • Demonstrated expertise and experience in Behavioral Health Services, including diagnosis of patients, assessment, treatment plans, and patient monitoring. Experience in utilization management, case management and community services is desired.
  • Medicare and Medicaid experience preferred

Our Comprehensive Benefits Package:

  • Flexible work solutions including remote options, hybrid work schedules and dress flexibility
  • Paid Time Off including paid holidays
  • Health insurance coverage for you and dependents
  • 401(k) and stock purchase plans
  • Tuition reimbursement and best-in-class training and development