Medical Director

3 months ago

Philadelphia, United States Community Behavioral Health. Full time
Job DescriptionJob Description

The Medical Director of Quality Management is responsible for the overall medical leadership to the department of Quality Management and the implementation of continuous quality improvement throughout the provider network, as well as within the departments at CBH.

Core Expectations:

Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission, vision, and corporate code of conduct.

  • Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
  • Serve as a role model by exemplifying professional behavior, language, skills, and attire in order to promptly and accurately serve the needs of stakeholders, members and their families.
  • Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost effective manner.
  • Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality, dignity and rights.
  • Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
  • Actively participate in required meetings and complete all mandatory trainings.
  • Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.
  • Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste or abuse.

Essential Functions:

  • Participate in and provide feedback for Quality Management activities including complaint and grievance decisions, quality care concerns, chart reviews, and significant incident reports.
  • Provide oversight and evaluation of pro re nata (PRN) physician advisors in the quality department. Conduct reviews of PRN physician advisor’s performance with regard to quality work.
  • Participate in the development of quality standards and clinical practice guidelines for the network, specific to levels of care and diagnoses ensuring alignment with other strategic priorities
  • Give feedback to network providers regarding quality of care, as well as assist with oversight of Quality Improvement Plan development, implementation, and monitoring.
  • Oversee development and implementation of program evaluations within the network and internally to ensure quality of care
  • Develop and monitor quality metrics to identify trends and ensure targets are met both across the provider network and for OMHSAS required projects.
  • Provide feedback to physician advisors and the clinical department regarding quality standards and quality of care concerns
  • Produce, review, finalize and present Quality Management reports to CBH’s board of directors, Quality Improvement Committee, and OMHSAS
  • Lead Quality Improvement Committee in conjunction with the Senior Director of Quality Management
  • Provide physician leadership to ensure maintenance of NCQA accreditation for the health plan, including Health Equity and Managed Behavioral Healthcare Organizations.
  • Participate and lead various meetings related to Quality and medical leadership. Meetings occur both in the office and throughout the network as needed.

Position Requirements:

  • Education: MD or DO from accredited medical school; completion of residency in psychiatry from accredited residency program
  • License/Certification: Board certification in psychiatry required; PA Medical License required;
  • Certified Professional in Healthcare Quality preferred
  • Relevant Work Experience: Minimum of 3 years post-residency experience; experience in quality management activities is preferred

Skills:

  • Ability to work collaboratively with cross-system partners
  • Excellent verbal and written communication skills and ability to interact with broad range of individuals
  • Strong mediation skills
  • Ability to work independently in fast-paced environment
  • Compliant with HIPAA regulations

Work Conditions (including travel, overtime required, physical requirements and occupational exposure):

  • This position spends time in the office, the field interacting with providers and requires travel within Philadelphia and surrounding counties.
  • Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
  • Ability to utilize computers and office equipment to complete daily work responsibilities.
  • Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
  • Must be able to adapt to continuous changes/demands of the job.
  • On Call: may vary based on staffing needs up to 10 weeks per year.

U.S. Authorization Requirement:

  • CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

  • We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

  • CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
  • If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov


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