Medical Director
4 weeks ago
Responsibilities include:
- Providing clinical case management advisement, treating provider contacts, and employee contacts.
- Developing strategic plans and providing oversight of behavioral health claim management services.
- Assisting case managers in understanding the emotional, behavioral, and cognitive functioning of employees/claimants in relation to work demands.
- Offering initial and ongoing clinical guidance, reviewing treatment plans, and assessing standards of care for projected return-to-work dates.
- Conducting comprehensive disability claim file reviews and peer-to-peer consults to address specific questions and claim dynamics.
- Supporting operational functions through consultation with clients, vendors, internal leadership, and case managers.
- Directing and coordinating psychiatric reviews and complex claim discussions related to disability, accommodations, and permanent restrictions.
- Providing physician coverage for the team when the lead physician is unavailable.
Additionally, providing clinical oversight and training to a team of nurse and behavioral health case managers, including:
- Consulting and interpreting information related to psychiatric disability and leave of absence claims.
- Training case manager personnel on various behavioral health topics.
- Providing ongoing support through consultation and daily "walk-in" hours for case management discussion.
- Conducting file reviews, peer-to-peer consults, and negotiations with treating providers.
- Negotiating with employees and clients/employers to streamline return-to-work processes.
- Utilizing client wellness resources and critical thinking skills to ensure optimal outcomes.
- Collaborating with client Human Capital Management and Employment Law teams in managing medical leaves of absence and accommodations.
Requirements:
- Active state or jurisdiction healthcare provider licensure.
- Board Certification from the American Board of Psychiatry and Neurology (ABPN).
- Minimum 5 years of experience in reviewing disability claims related to psychiatric conditions.
- Maintains Applicable Certifications (e.g., The American Board of Independent Examiners, The American Academy of Disability Evaluating Physicians).
- Demonstrates empathy, compassion, and professionalism in interactions with customers and in coaching case managers.
- Champions change management and leads initiatives to ensure best practices are implemented.
- Possesses a strong working knowledge of medical and behavioral health disorders.
- Can integrate quickly into a fast-paced working environment and develop valuable interpersonal business relationships with stakeholders.
- Able to convey clinical opinions clearly and efficiently to non-clinical stakeholders.
- Receptive to feedback.
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