Job: Medical Director-Psychiatrist-Salt Lake County UT
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1. Responsible for achieving appropriate utilization by performing reviews, denials, peer reviews and appeals; consulting with care management staff; using data to identify opportunities for improvement and implementing strong action plans.
2. Responsible for implementing a recovery philosophy working closely with the Recovery & Resiliency Unit by maintaining a knowledge base in rehabilitation and recovery principles and innovations; modeling principles of engagement, empowerment and learning with colleagues and employees, and training all staff in the practical implications of these principles with a particular emphasis on care management, alternative levels of care and network sufficiency.
3. Provide clinical leadership to Care Management and QA/PI staff.
4. Provide supervision to other contracted medical staff that performs UM functions for OptumHealth Salt Lake County.
5. Provide weekly supervison/inservice training to both OptumHealth SLCO clinical staff and other clinical staff focusing on medical necessity, reason for inpatient admissions, state requirements, appropriate psychiatric practice and engagement, empowerment, recovery and rehabilitation.
6. Provide peer to peer reviews and consultations.
7. Consult directly with other physicians to represent the OptumHealth SLCO in clinical disputes, and act as a liaison with OptumHealth SLCO service area physicians and agencies as requested.
8. Decide appeals according to medical necessity criteria when not involved in the Adverse Determination.
9. Chair the Quality Management Committee and Utilization Management Committee on a monthly basis.
10. Provide all necessary reports on UM activities.
11. Provide authorization for all requests for inpatient admissions for children and adolescent.
12. Complete all medical necessity reviews when Care Managers are unable to authorize inpatient admission or continued stay. Assist when necessary In the case of an expedited review request by the hospital.
13. Provide sufficient electronic documentation in the consumer record when a denial is made for either adult or child/adolescent.
14. Establish criteria and procedures for the Medical Director Review of clinical cases.
15. Provide Professional Testimony as requested by OptumHealth SLCO in judicial proceedings on Involuntary Commitment and clinical consultations in SLCO grievance proceedings.
16. Provide consultation to SLCO Management and staff regarding such issues as clinical standards, policies, procedures, recovery and resiliency and best practices.
17. Assist SLCO in reviewing and assessing SLCO Level of Care Manual annually.
18. Provide in service training for staff on managed care and general clinical issues in order for staff to understand direct service vs. care management in a managed care environment.
19. Provide brief phone consultations within 20 minutes of the initial request made via phone by SLCO staff. Phone consultations should be available 24/7 unless other coverage is arranged in advance.
20. Conduct clinical reviews of contracted provider clinical records as requested.
21. Provide for availability of services Monday through Friday 20 hours a week on site and coverage by phone 24/7 except for paid time off when backup will be arranged.
Primary responsibility for ensuring access and delivery of cost effective quality care that incorporates recovery, resiliency and person-centered services. Responsible for Level of Care guidelines and utilization management protocols. He/she is responsible for oversight and management with the Clinical Manager all utilization review and management activities. The Medical Director will provide clinical oversight to the Care Managers, oversee inpatient hospitalizations; and keep current regarding prevalent treatment protocols and philosophies including those that address consumer cultural preferences. Responsible for maintaining the clinical integrity of the program, including review of authorization requests; providing oversight to utilization and quality and care management teams; providing consultation to the Medical Health Plans, providers and other community based clinicians, including general practitioners. Will provide timely psychiatric services for the OptumHealth SLCO including communication with clinical and contracting staff and network providers, medical necessity review and recommendations, service denial reviews, grievance issues, medication reviews, clinical best practices guideline development, and weekly care management case reviews.
Skills / Requirements
1.Licensed Utah MD; Board Certified in Psychiatry, sub specialty in child, geriatric or addictions desirable. Minimum of five years of experience as a practicing psychiatrist and three years of supervisory experience.
2.One year plus experience in managed care doing utilization Management.
3.Demonstrated understanding of the clinical application of the principles of engagement, empowerment, rehabilitation and recovery.
4.Demonstrated commitment to assisting people to maintain in the community with maximum independence and self sufficiency and understanding of the appropriate use of wraparound, in home stabilization services and natural community supports to maximize community tenure.
5.Demonstrated ability to lead and teach others.
6.Demonstrated ability to proactively engage colleagues and manage adversarial situations.
7.Excellent communication and interpersonal skills.
8. Ability to perform a highly diverse level of tasks and deliver quality outcomes in alignment with OptumHealth mission
9. Experience working with community based programs and resources designed to aid the Medicaid population, Medicare or other special needs populations.
10. Knowledge of post acute care planning such as home care, discharge planning, case management, and disease management.
11. Local travel required.
12. PC proficiency, data analysis and strong organizational skills necessary. Excellent communication, negotiation and customer service skills required.
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.
By providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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