The Sr. Behavioral Medical Director position is responsible for providing oversight to and direction of the Utilization Management Program and performing peer reviews as necessary. This individual will interact directly with Psychiatrists, Prescribers, and other clinical professionals who consult on various processes and programs. It will include roles which manage development and implementation of medical expense initiatives. The Director will also advise leadership on improvement opportunities regarding medical expense programs and clinical activities that impact medical expense. Our clinical vision drives the team to improve the quality of care our consumers receive. Primary Responsibilities: Consults with Care Advocate staff Conducts provider telephonic review and discussion, schedules on-site visits and shares information related to cost effective health care delivery and quality of care Conducts Peer Reviews Conducts appeals Interfaces with Professional Groups and Network Providers Actively participate in committees and meetings Seeking individual who is willing to work as part of a multidisciplinary team as an equal with team members Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
Exigências do Cargo: - Superior completo em Enfermagem- Pós graduação ou Especialização completa- Coren ativo- Experiência em Pronto atendimento.
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.