AmeriHealth Caritas Medical Director (Child Psychiatrist) in Robbinsville, New Jersey
Medical Director (Child Psychiatrist)
Location: Robbinsville, NJ
Medical Director Behavioral Health
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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
The Medical Director is responsible for medical policy pertaining to the quality of behavioral health care. He/she is the designated behavioral health care practitioner with oversight of the Quality Improvement (QI) program. The Medical Director is an active participant in QI Committee meetings providing clinical consultation, and holds final authority for recommendations for medical necessity and appropriateness or quality of care decisions. The PerformCare Quality Improvement (QI) program provides the structure and processes to measure and inform the system of care and key stakeholders of their performance and ability to meet program goals. The Medical Director reviews and approves the Outcomes Management and Quality Improvement Plan.
The Medical Director provides clinical oversight and direction to the Clinical Department. This position is responsible for providing consultation and determinations for clinical cases in need of review. The Medical Director supports the clinical department in applying Medical Necessity Criteria to render determinations for requests for a specific intensity of service. In addition, the Medical Director will assess clinical aspects of specific cases and provide feedback to Care Coordinators and Reviewers pertaining to best practice standards and quality of care issues. This position assists in the development of Medical Necessity Criteria, performs utilization management activities, provides insight into youth outcome trends, and validates Certificate of Need for youth admitted to certain Out of Home providers. Assures that organizational medical policies and procedures adhere to contractual obligations.
The Medical Director has supervisory responsibility over Physician Advisors and Psychologists.
10 or more years in direct care/administration.
Demonstrable understanding of mental health, intellectual/developmental disabilities, adolescent substance use, and child protective services within the contract of a managed care model is required.
Understanding of Medicaid, HIPAA and 42 CFR.
Strong time management, project management, analytical, and organization skills.
MD (Board Certified Child/Adolescent Psychiatrist)
Master's Degree (Required from an accredited educational program in Social Work, Clinical Counseling, Psychology, Nursing or Behavioral Clinical Specialty.)
EOE Minorities/Females/Protected Veterans/Disabled