CTG MEDICAL DIRECTOR- BEHAVIORAL HEALTH in Las Vegas, Nevada
Title: MEDICAL DIRECTOR- BEHAVIORAL HEALTH
Location: US-NV-Las Vegas
Job Number: 17203928
Our client in the healthcare industry has an immediate opportunity for a Medical Director to assist the Senior Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. This is a full time placement opportunity located in Las Vegas, NV.
Our client is committed to improving the health of the community through health insurance solutions for the under-insured and uninsured, and through specialty services that align with their focus on whole health. Our client provides health plans through Medicaid, Medicare and the Health Insurance Marketplace and other Health Solutions through their specialty services companies.
Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers.
Assists Senior Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
Assists the Senior Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies.
Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees
Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine)
Five years’ experience working in a behavioral health managed care setting or a behavioral health clinic setting
Shall have appropriate training and expertise in general psychiatry and/or addiction disorder
The candidate must be an actively practicing physician
Previous experience within a managed care organization preferred
Course work in the areas of Health Administration, Health Financing, Insurance and/or Personnel Management preferred
Experience treating or managing care for a culturally diverse population preferred
License/Certifications: Board Certification through American Board of Psychiatry and Neurology. Current state medical license without restrictions.
TO APPLY :
To be considered for this opportunity apply to this requisition via the “Apply” button below or go to www.ctg.com/careers and search on CTG Careers for 17203928; and/or contact Betsy Vyce; firstname.lastname@example.org.
CTG is the most reliable IT services provider, built on 50 years of meeting our commitments to make technology work for clients and deliver real business value. CTG provides industry-specific IT strategy, services, and solutions that address the business needs and staffing challenges of clients in high-growth industries, including major technology companies, large corporations, and government entities located in North America and Western Europe.
CTG's greatest asset is its people, and as such we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work Company by Modern Healthcare (since 2013) in North America, and a Best Places to Work Company in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).
CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.
CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.