Plan Performance Medica Director- CT Behavioral Health Partnership
Location: Remote position but candidate must reside in CT or willing to relocate to CT.
Build the Possibilities. Make an extraordinary impact.
Responsible for serving as the Behavioral Health (BH) Medical Director lead clinician for the CT Behavioral Health Partnership (CTBHP) account. Responsible for the administration of BH medical services for the CTBHP including the overall BH medical policies or clinical guidelines to ensure the appropriate and most cost-effective medical care is received. Drives direction of the CTBHP contract related to BH cost of care and other contract directives. Works with the market plan president during meetings with State Regulators. Provides liaison from account/market to State, Health Plan Leadership, Clinical Services Team, BH Leadership, Manager Medical Director, cost of care work groups, client partnership, and others as need to support business unit in the specific market. Monitors PIE/audit outcomes. Assists Manager Medical Director with monitoring/supporting inter rater reliability participation and outcomes. Meets regularly with account/market BH Director to address and improve utilization management and case management operations. Serves as resource/subject matter expert regarding local contractual and or regulatory requirements related to utilization/case management and market/account-specific strategy. Provides consultation to the plan, as needed, regarding quality concerns and state fair hearings. Coordinates with Physical Health counterparts to improve the delivery of whole person care.
How you will make an impact:
- Supports the BH Medical Management staff to ensure timely and consistent responses to members and providers.
- Provides guidance for clinical operational aspects of a program.
- Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations.
- May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
- Interprets existing policies or clinical guidelines and develops new policies based on changes in the healthcare or medical arena.
- Leads, develops, directs, and implements clinical and non-clinical activities that impact efficient and effective care.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
- Provides expertise, captures, and shares best practices across regions to other medical directors.
- May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.
- Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
- Requires active unrestricted medical license to practice medicine in CT.
- Board certification in Psychiatry.
- Addiction Medicine certification required.
- Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
- Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Travel within CT may be required.
- If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.
- Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
- Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
- Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.