Job: Adult Medical Director-MARICOPA

JOB SUMMARY
The Adult Medical Director provides oversight of comprehensive medical policy implementation and utilization management services for the adult system of care. The Adult Medical Director develops and sustains an interface with member forums and facilitates the deliver of appropriate care to adult enrollees.

ESSENTIAL FUNCTIONS
Responsible for the development of the clinical mission, including the implementation and evaluation of clinical and medical adult programs to ensure the delivery of quality care to recipients in the adult system.

Provides medical leadership, oversight and consultation for the Quality Improvement Program and the Utilization Management Program including: monitoring effectiveness and compliance with goals, prevention programs, network development and management, quality of care concerns and adverse incidents, medical practice of network of sub-capitated providers, clinical service delivery system, coordination with after hours teams and appeals, panel physicians, and oversight of clinical appeals. Works collaboratively with QI on the development and implementation of QI activities, UM and QI program descriptions, evaluations and work plans.

Directs the utilization review process and oversees the quality of utilization determinations for the adult population. Ensure compliance with clinical goals through regular monitoring of care management center performance. Evaluates the effectiveness of the clinical program and modifies programs as needed to achieve desired results.

Participates in member forums to gain valuable feedback about the delivery system. Evaluates the quality of medical staff and physician advisors to ensure compliance with DBHS and Magellan standards of practice. Develops and manages the physician advisor budget.

Participates in the development, implementation and interpretation of medical policy for adult enrollees, including: Medical Necessary Criteria, Clinical Practice Guidelines, and New Technology Assessments.

Directly supervises the ACT Manager and the ACT Medical Director.

MINIMUM REQUIREMENTS
Education: MD
Experience: 5-8yrs.
Job Specific: Post-residency experience of a least 5 years involving substantial direct patient care. Clinical experience in serving the adult population. Knowledge of current research, recovery/resiliency principles, and psychopharmacologic and psychotherapeutic modalities of treatment.

Knowledge, Skills, Abilities:
Licenses, Certifications, etc.: Active AZ license and AZ resident. Board certified by the American Board of Psychiatry and Neurology.

PREFERRED QUALIFICATIONS
Experience: Managed care, as provider or manager of care. Utilization review.