What are the responsibilities and job description for the Medical Director of Behavioral Health position at Sunshine State Health Plan?
Job Summary:
The Medical Director of Behavioral Health will be responsible for directing and coordinating the medical management, quality improvement, and credentialing functions for our business unit. This role requires a medical professional with expertise in utilization management, cost containment, and medical quality improvement activities.
Key Responsibilities:
Requirements:
The Medical Director of Behavioral Health will be responsible for directing and coordinating the medical management, quality improvement, and credentialing functions for our business unit. This role requires a medical professional with expertise in utilization management, cost containment, and medical quality improvement activities.
Key Responsibilities:
- Provides medical leadership to ensure timely and quality decision-making in utilization review, quality assurance, and medical review of complex cases.
- Supports effective implementation of performance improvement initiatives for capitated providers, focusing on quality and cost-effectiveness of care.
- Assists in planning and establishing goals and policies to improve quality and cost-effectiveness of care and services for members.
- Collaborates effectively with clinical teams, network providers, and medical consultants to review complex cases and medical necessity appeals.
Requirements:
- Medical Doctor or Doctor of Osteopathy degree.
- Utilization Management experience and knowledge of quality accreditation standards are preferred.
- Board certification by the American Board of Psychiatry and Neurology is required.
- A current Florida state medical license without restrictions is also required.
