JOB TITLE: SeniorMedical Director, Behavioral Health
LOCATION: Geisinger Health Plan (GHP)
WORK SCHEDULE: Days/Evenings
WORK TYPE: Full-Time
Geisinger Health Plan (GHP) is seeking a Psychiatrist to serve as Senior Medical Director for the Behavioral Health Operations. The scope and breath of responsibility for the Senior Medical Director Behavioral Health is to collaborate with GHP leadership to identify, develop, implement, and evaluate behavioral health strategic initiatives to promote the delivery of high quality, constituent responsive medical care. The Senior Medical Director will work in conjunction with the other behavioral health leaders in the development of integrating Behavioral Health utilization management and behavioral health case management at Geisinger Health Plan. Must maintain a comprehensive and long-range system view of Geisinger Health Plan’s strategic plan, which constantly seeks to identify and take advantage of new business opportunities to improve the health and wellness of the patients and families served. Experience with the SMI population (Seriously Mentally Ill) for this role is critically important.
MAJOR DUTIES AND RESPONSIBILITIES:
1. Management and oversight of the Behavioral Health Medical Directors
2. Oversight and review of medical policies, clinical guidelines, quality and clinical operations to ensure NCQA compliance.
3. Works in conjunction with the provider network team on a strong clinical network, including provider relationships.
4. Evaluates the effectiveness and cost of care of clinical programming through utilization and financial analysis; modifies programming as needed to achieve positive results.
5. Leads the clinical staff in the coordination of quality care on behalf of members utilizing their available benefits.
Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities, in the execution of precertification, concurrent review/discharge planning, case management, disease management, quality management, disability management, Grand Rounds and clinical claim review.
Tracks and trends under and over utilization of behavioral health services to identify opportunities for improvement, followed by implementation of policies and procedures to initiate and monitor the impact the behavioral health utilization management and case management activities.
Provides clinical guidance in operating effective medical programs to promote member quality of care and in reviewing potential lapses in the quality of care.
Assists the quality department in the development of annual QI plan for all programs and assures all indicators are met.
Analyzes data to identify quality improvements.
Acts as a mentor to employees and supports ongoing training and development of clinical staff.
SKILLS AND ABILITIES:
Experience working with the SMI (Seriously Mentally Ill) population
Foster a culture of caring for patients and employees
Demonstrate competence in written, oral, and electronic communication skills
Ability to direct and coordinate programs, projects, resources, and staff across multiple company functions
Strong analytic qualities to analyze goals, products, programs, and processes and make recommendations for changes
Knowledge of managed care, utilization management, case management, and disease management
Organizational and project management skills
Experience working with clinical documentation programs designed for utilization management programs
Ability to work well and mentor colleagues
EDUCATION AND/OR EXPERIENCE:
5 years of experience in an integrated health care delivery system, clinical practice and healthcare industry. Managed care experience is a preferred.
The highest level of education required is a MD/DO.
LICENSES AND CERTIFICATION:
Medical/Board Certified, Psychiatry is required. An active unrestricted medical license in the State of Pennsylvania is required or the ability to obtain an active unrestricted license in Pennsylvania is required within 2 months of hire.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment
Travel to sites throughout Geisinger Health Plan network
Off-Site travel for regulatory meetings
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
ABOUT GEISINGER: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitte
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.