Harris Health System

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Behavioral Health/Medical Director/ CHC

at Harris Health System

Posted: 5/2/2019
Job Status: Full Time
Job Reference #: 145249
Keywords:

Job Description

About Us

Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Job Profile

The Behavioral Health Medical Director position is responsible for providing oversight to and direction for the Behavioral Health Case Management and Utilization Management/Appeals Teams. The Medical Director will facilitate integrated Behavioral Health Rounds and interact directly with Psychiatrists, Behavioral Health Providers, and other clinical professionals who consult on various processes and programs. The Behavioral Medical Director is part of a leadership team that manages development and implementation of evidence-based guidelines and medical expense initiatives and will advise leadership on health care system improvement opportunities. They are responsible for maintaining the clinical integrity of the program, including timely coverage determinations, medical necessity reviews and determinations, appeals, peer-to-peer discussions, and consultations with providers and other community based clinicians, including general practitioners. This Medical Director will work collaboratively with the Health Plan Medical Director, and the Health Plan's Clinical, Network and Quality teams.

QUALIFICATIONS:

  • MD/DO, holds a valid Texas license to practice medicine and be registered as a physician in the State of Texas.
  • Board Certified or eligible Psychiatrist for initial employment.
  • Board certification is required. Must meet credentialing criteria.
  • Two years' experience in a managed care environment.
  • Three years' experience as a practicing psychiatrist post residency; Adult Psychiatrist preferred; Child and Adolescent Psychiatry accepted.
  • Experience working with community based programs and resources designed to aid the State Medicaid and Medicare population required. Knowledge of post- acute care planning such as home care, discharge planning, and disease management.

OTHER SKILLS:

  • Advance PC skills, MS Word, MS Excel, MS Outlook
  • Above Average Verbal communication skills (Heavy Public Contact)
  • Writing /Composing (Correspondence/Reports )
  • Analytical
  • Medical Terminology
  • Advanced Training Specialty: Adult Psychiatrist preferred; Child and Adolescent Psychiatry accepted.
  • Excellent organization, coordination, and multi-tasking skills and abilities. Ability to organize and prioritize tasks and work independently. Strong attention to detail and deadlines
Benefits and EEOC

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Application Instructions

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