Interim Behavioral Health Medical Director

Location: Boston, MA
Date Posted: 02-08-2019
CareNational
Medical Director of Behavioral Health (MD) - Managed Care
Boston, MA

*** This is a Full-Time, Benefits Available, INTERIM / CONTRACT position expected to last several months or longer!  ***

Medical Director Job Summary:
  • The Medical Director of Behavioral Health programs will support the staff of the Office of Clinical Affairs in medical management including utilization review and concurrent review
  • May also be involved with other internal processes such as quality, appeals and grievances, and pharmacy management
  • Provides clinical case review, consultation and oversight for all utilization management activities
  • Conducts review of prior authorizations, concurrent reviews and retrospective reviews that do not meet standard criteria and determines coverage
  • Conducts clinical review of appeals and grievances
  • Develops and supports clinical initiatives to support department quality improvement and utilization management goals

 
Medical Director Background: 
  • Current unrestricted licensure as an M.D. in Massachusetts is required. Board certification in psychiatry is required
  • Prior experience performing Utilization Reviews
  • Experience in a health insurance or other managed care setting strongly preferred
  • Knowledge of InterQual protocols, HEDIS, and other quality measures
  • Knowledge of federal Medicaid and MassHealth regulations, guidelines, and standards Experience with prior-authorization, utilization review, and appeals
  • 8-10+ years of related experience is required including a minimum of 5 years direct clinical experience and a minimum of 3 years experience in medical management in a managed care setting
  • Comprehensive knowledge of InterQual protocols, HEDIS, and other quality measures
  • Knowledge of federal and state Medicaid regulations, guidelines, and standards
  • Proven leadership skills and relationship building. Ability to work independently with intermittent supervision
  • Ability to travel to locations within New Hampshire and Massachusetts 
 
#CLINICAL
 
 
RON AMODIO
STRATEGIC DIRECTOR
CareNational
ron@carenational.com
480.269.9491 (CALL – TEXT – FAX)
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