Note: The job is a remote job and is open to candidates in USA. CareSource is a company focused on providing quality healthcare services, and they are seeking a Clinical Psychologist to oversee Behavioral Health coverage determination. The role involves ensuring members receive appropriate care, developing clinical policies, and leading quality improvement initiatives.
Responsibilities
- Assume responsibility for the overall safety of patients with a BH diagnosis
- Serve as the clinical lead in developing and implementing evidenced based clinical policies and practices
- Participate in regulatory/accreditation reviews
- Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
- Oversight and quality improvement activities associated with case management activities
- Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
- Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
- Represent CareSource as the primary clinical liaison to members, providers and State agencies
- Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
- Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
- Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
- Collaborate with market/product leaders to help define market strategy
- Community collaborative participation
- Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
- Provide cross-coverage for Behavioral Health Medical Directors and/or markets, as needed
- Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
- Perform any other job related instructions, as requested
Skills
- Completion of an accredited clinical psychology program is required
- Successful completion of a doctoral internship program in psychology is required
- Minimum of three (3) years of clinical practice experience is required
- Current, unrestricted license to practice psychology in state of practice as necessary to meet regulatory requirements is required
- MCG Certification is required or must be obtained within six (6) months of hire
- Basic Microsoft Word skills
- Excellent communication skills, both written and oral
- Ability to work well independently and within a team environment
- Ability to create strong relationships with Providers and Members
- High ethical standards
- Attention to detail
- Critical listening and systematic thinking skills
- Ability to maintain confidentiality and act in the company's best interest
- Ability to act with diplomacy and sensitivity to cultural diversity
- Decision making/problem solving skills
- Conflict resolution skills
- Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
- Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns
- Leadership experience and skills
- Managed care medical review/medical director experience is preferred
- Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred
Benefits
- In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
- We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
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