Medical Director for Adult Services

Company: Community Behavioral Health.
Location: Philadelphia
Posted on: November 14, 2024

Job Description:

The Medical Director of Adult Services is responsible for providing administrative oversight and supervision of the CBH physician advisors conducting utilization review for our adult members. The position provides leadership in the development and implementation of clinical/medical policies and initiatives as well as engagement of cross-systems stakeholders for adult services. The Medical Director may also conduct utilization reviews and will participate in the physician's after-hours call coverage.The Medical Director of Adult Services must be committed to fostering a supportive and collaborative environment, encouraging teamwork and mentorship at every level. This requires exemplary communication skills with both internal and external stakeholders. He/she must support the mission, vision, and values of CBH and DBHIDS.Core Expectations: Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission, vision, and corporate code of conduct.

• Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
• Serve as a role model by exemplifying the highest standards of professional behavior, language, skills, and experience in order to promptly, accurately, and compassionately serve the needs of stakeholders, members and their families.
• Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner.
• Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting individuality, cultural differences, dignity, and rights.
• Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
• Actively participate in required meetings and complete all mandatory training.
• Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and its mission.
• Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste or abuse.
• Champion member safety and well-being as the top priority in day-to-day operations.Essential Functions:
  • Builds and maintains a strong functional team through effective recruiting, training, performance management, coaching, team building and succession planning.
  • Provides supervision, guidance and leadership of adult physician advisors regarding clinical review of cases for medical necessity and care management
  • Establishes and monitors performance expectations for adult physician advisors
  • Monitors physicians' productivity and effectiveness in conducting peer utilization review
  • Ensures physician review processes and content are aligned with best practice standards (NCQA) and state regulatory requirements
  • Coordinates physician schedules to ensure adequate coverage (including nights/weekends/holidays) of clinical services
  • Partners with leadership team to ensure optimal care management and medical review functioning leading to improved outcomes for CBH members
  • Provides medical leadership related to overall quality of care, medical decision making, case formulations, appropriate use of medication and other treatment modalities while addressing safety concerns specific to case review and levels of care
  • Engages, collaborates and troubleshoots with providers and system stakeholders on clinical and administrative matters, including member placement, coordination of care, quality concerns and other challenges
  • Participates in quality reviews as needed for specific member complaints, grievances, and agency reviews
  • Participates in clinical and administrative meetings as required
  • Participates in training and education with both internal and external stakeholders, including care managers, providers and others as required.
  • Demonstrates deep personal commitment to the Mission, Vision, and work of the CBH and DBHIDS
  • Maintains expertise/education/training regarding most up-to-date standards of care
  • Possesses leadership and medical experience necessary to effectively take on the tasks inherent in this role. Position Requirements:
    • Education: Medical degree
    • License/Certification: State license in the Commonwealth of Pennsylvania; Board Certification in Adult Psychiatry
    • Relevant Work Experience: Minimum of 3 years of experience in clinical psychiatry, preferably including inpatient exposureSkills:
      • Problem solving and strong analytical skills
      • Excellent interpersonal skills
      • Flexibility in assessing situations and evaluating needs
      • Proficient in Microsoft Word and Excel
      • Strong administrative and managerial skills
      • Excellent verbal and communication skills Leadership Competencies:
        • Strategic Thinking: Understand and integrate the long-term vision of CBH and focus current activities on what is critical to achieve future success including formulating objectives/priorities and developing and implementing breakthrough ideas.
          • Leadership: Effectively manage and guide efforts to address challenges and drive continuous improvement for CBH's programs, services and processes. Develop and implement effective strategies and tailor appropriate interpersonal styles to influence and guide others.
            • Employee Development: Recognize and promote the necessity to hire, assess, develop and retain high quality talent. Acknowledge strengths and weaknesses in team members through an ongoing performance management process that provides timely feedback in order to aid employee development and enhance team performance. Work Conditions (including travel, overtime required, physical requirements and occupational exposure):
              • Must be able to travel within the City of Philadelphia.
              • Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
              • Ability to utilize computers and office equipment to complete daily work responsibilities.
              • Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
              • Must be able to adapt to continuous changes/demands of the job.U.S. Authorization Requirement:
                • CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.Equal Employment Opportunity:
                  • We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.Requesting An Accommodation:
                    • CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
                    • If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at PIb59b88cad806-31181-34529607

Keywords: Community Behavioral Health., Union City , Medical Director for Adult Services, Executive , Philadelphia, New Jersey