Virginia Premier Health Plan Behavioral Health Medical Director in Glen Allen, Virginia

Overview

The Behavioral Health Medical Director is responsible for medical management clinical functions including Utilization Management, Quality Improvement, Credentialing and Pharmacy for Behavioral Health and Substance Abuse Disorders. He/She will improve the health care delivery system for effective delivery of behavioral health care and will be the Behavioral Health clinical subject matter expert at Virginia Premier. The BHMD will supervise the Associate Behavioral Health Medical Director in addition to partnering with the Chief Medical Officer as a Behavioral Health partner. The role will have an integral part in the development of Behavioral Health programs for Virginia Premier, developing and implementing strategies for growth. The Behavioral Health Medical Director will be a member of the Virginia Premier Health Quality Utilization Management (HQUM) Committee.

Responsibilities

  • Assisting the CMO and Medical Directors in the following activities:

  • Behavioral Health Utilization Management

  • Behavioral Health Quality Assessment and Improvement activities

  • Outreach programs and developing partnership opportunities

  • Development of practice and preventive guidelines

  • Ensuring regulatory and accreditation compliance

  • Serving as a Virginia Premier representative in designated local meetings with managers, provider offices, local and state health care organizations

  • Reviewing pharmacy requests and appeals to determine medical necessity

  • Monitoring of provider performance

  • Recommending departmental improvements

  • Resource for Medical Management staff for care coordination and management for ambulatory and inpatient services

  • Acting as medical reviewer on appeals

  • Demonstrating collaboration with Virginia Premier staff and management to achieve goals and objectives of the department and organization

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Current Unrestricted Virginia Physician License, or the ability to obtain one

  • Board Certified Psychiatrist required

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Commitment to Virginia Premier’s clinical programs and mission to serve the Medicaid population

  • Ability to work with colleagues and other health care professionals to resolve utilization and quality management issues

  • Ability to communicate effectively with health professionals, administrators and staff, both orally and in writing

  • Ability to review the medical literature to answer a clinical question

  • Basic computer skills

WORK BACKGROUND/EXPERIENCE

  • Minimum of five years clinical experience

  • Experience in managed care medical management preferred

PHYSICAL REQUIREMENTS

  • Physicalhealth sufficient to meet the ergonomic standards and demands of the position

About Us

Virginia Premieris a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Health Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

Our mission is to inspire healthy living within the communities we serve!

Job ID 2018-4831

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.