Clinical Psychologist(Preferred Experience In Substance Abuse & Managed Care)

Job Summary:

The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting.

Essential Functions:

• Assume responsibility for the overall safety of patients with a BH diagnosis
• Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
• Participate in regulatory/accreditation reviews
• Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
• Oversight and quality improvement activities associated with case management activities
• Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
• Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
• Represent CareSource as the primary clinical liaison to members, providers and State agencies
• Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
• Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
• Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
• Collaborate with market/product leaders to help define market strategy
• Community collaborative participation
• Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
• Provide cross-coverage for Behavioral Health Medical Directors and/or markets, as needed
• Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
• Perform any other job related instructions, as requested

Education and Experience:

• Completion of an accredited clinical psychology program is required
• Successful completion of a doctoral internship program in psychology is required
• Minimum of three (3) years of clinical practice experience is required
• Managed care medical review/medical director experience is preferred

Competencies, Knowledge and Skills:

• Basic Microsoft Word skills
• Excellent communication skills, both written and oral
• Ability to work well independently and within a team environment
• Ability to create strong relationships with Providers and Members
• Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred
• High ethical standards
• Attention to detail
• Critical listening and systematic thinking skills
• Ability to maintain confidentiality and act in the company’s best interest
• Ability to act with diplomacy and sensitivity to cultural diversity
• Decision making/problem solving skills
• Conflict resolution skills
• Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
• Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns
• Leadership experience and skills

Licensure and Certification:

• Current, unrestricted license to practice psychology in state of practice as necessary to meet regulatory requirements is required
• MCG Certification is required or must be obtained within six (6) months of hire

Working Conditions:

• General office environment; required to use general office equipment
• May be required to work evenings/weekends
• May be required to travel in-state to fulfill duties of position