Medical Director Psychiatrist (Provider Part-Time) - Upper Darby
Company: medtigo staffing, LLC
Location: Upper Darby
Posted on: January 27, 2023
Psychiatric-Mental Health opening in Upper Darby, Pennsylvania.
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Regional Medical Director Provider (Delaware County, Part-Time)
BC / BE Psychiatrist to fulfill the role of Regional Medical
Director and offer administrative services in our Delaware County
Office. The Regional Medical Director is responsible for assuring
the quality and efficiency of the health care delivered to
Community Care members. This includes significant responsibility
for quality management and utilization management and for assuring
the adequacy of the provider network for the clinical needs of
Community Care members. The Medical Director also participates in
regional leadership policy decisions and strategic planning. In
addition, the Regional Medical Director is a resource to
participating providers in the provision of quality medical care.
This psychiatrist would report to the Senior Medical Director and
provide clinical and medical supervision to the care management and
quality management staff in our office in Delaware County,
Community Care is a public behavioral health managed care
organization (BH-MCO) that is part of the UPMC Insurance Division
that is both NCQA and URAC accredited. Duties could be
individualized and be offered within a weekly time frame of 20
hours. This will be a hybrid position with sometime in the office
as needed and remote work. There are no requirements for on-call,
weekend, or evening hours.
The Regional Medical Director would join a highly educated,
collegial and motivated team of physician advisors who advocate
well for the recovery from mental health and substance use
disorders for nearly a million individuals across Pennsylvania. He
or she would have the opportunity to be involved in many of the new
initiatives that include targeting enhanced service delivery for
specific populations, physical health/ behavioral health
integration, substance use treatment, residential treatment for
children, prescribing trends; some of which could result in
presentations and or journal publication.
Child and adolescent psychiatrists, adult psychiatrists as well as
psychiatrists with additional subspecialty training are welcome to
- Acts as a liaison for Community Care with community physicians,
hospital staff, and other professionals and agencies with regard to
- Acts as a physician reviewer for cases referred by care
- Advises the Regional Director on the development and review of
programs, positions, and budgets having an impact on clinical
- Assures effective and appropriate utilization of the various
levels of care in the provider network.
- Assures psychiatric involvement in the development, approval,
and review of all policies, procedures, and protocols governing
- Assures the quality of treatment and related services provided
by Community Care professional staff, through participation
(directly or by designee) in the ongoing quality management and
- Develops and maintains effective relationships with
- Ensures prompt and fair resolution of care management decision
- Ensures the quality of clinical care provided to Community Care
- Implements quality management programs and continuing education
- Interfaces with the Counties and DHS as indicated.
- Interfaces with the Physical Health MCO's through Medical
Director to Medical Director meetings, and participates in the
appropriate committees of physical health MCO's where applicable,
such as a pharmacy and therapeutics committee
- Meets or exceeds NCQA, URAC or other regulatory
- Reviews of complaints and grievances in accordance with
Community Care procedures, and to assure prompt response and action
at all stages of the complaint and grievance process.
- Reviews proposed service denials and supervises care managers
in the utilization of appropriate medical necessity criteria, and
ensures appropriate care management integration and
- Reviews the medical aspects of cost and utilization reports
generated by Medical Management Information System.
- Supports member satisfaction with the care management
- Supports provider satisfaction with the care management
- Works closely with the medical directors of physical health
MCO's to assure coordination between physical health and behavioral
health needs and services.
- Works with Provider Relations to enhance the working
relationship between Community Care and the providers in its
- Works with Quality Management in designing and evaluating
- Minimum 10 years clinical experience.
- Doctor of Medicine or Doctor of Osteopathy from an accredited
school. Unrestricted License in Pennsylvania.
- Post residency clinical experience
- At least 5 years of management experience preferred.
- Experience in managed care setting preferred
- Ability to implement medical policies, and to enforce those
policies through appropriate action.
- Ability to maintain effective professional liaison with all
levels of executive and medical staff, including professional and
institutional providers of care.
- Ability to implement programs of quality care analysis, peer
review, and professional education.
- Quality of clinical care provided to COMMUNITY CARE
- Effective and appropriate utilization of the various levels of
care in the provider network.
- Member satisfaction with the care management process.
- Provider satisfaction with the care management
- Meeting or exceeding NCQA standards and other applicable
- Prompt and fair resolution of care management decision
- Development and maintenance of effective relationships with
Licensure, Certifications, and Clearances:
- Act 34 Criminal Clearance
- MD or DO
Keyphrases: psychiatry jobs, psychiatrist jobs, psychologist jobs,
psychiatric nurse practitioner jobs
Keywords: medtigo staffing, LLC, Philadelphia , Medical Director Psychiatrist (Provider Part-Time) - Upper Darby, Executive , Upper Darby, Pennsylvania
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