MEDICAL DIRECTOR, CA
The Beacon Medical Director is responsible for the review of clinical cases and questions regarding medical necessity, quality of care, and overall clinical practice. He/she may be the designee for the Medical Director, as needed.
• Follow all pertinent Beacon policies and procedures, and specifically those related to authorization, clinical denials, modifications, reconsiderations and appeals.
• Conduct peer clinical review by telephone and/or in person, to provide opportunity for physician or other attending provider to discuss clinical information for purposes of initial determinations, or, in cases of non-authorization, for reconsiderations and/or appeals.
• Follow Beacon’s policies and procedures on Complaints and Incidents, as assigned.
• Conduct retrospective chart review, as assigned.
• Participate in NCQA and URAC accreditation process, as assigned.
• Participate in designated Beacon Committees and collaborate with other medical and administrative representatives affiliated with the Orange County Mental Health Plan and CalOptima.
• Assist in the planning and provision of in-service training and provider educational opportunities as needed.
Current, valid and unrestricted medical license required, with proof on date of hire. Re-verification will take place no less than every 3 years.
Clinically active MD or DO with six years experience, board certified in psychiatry. Knowledge of managed care required; knowledge of community psychiatry, child psychiatry, public sector populations, forensic issues strongly preferred. Academic experience and strong research and/or teaching background helpful, but not required.
Familiarity with Medi-Cal rules and regulations applicable to the provision of Specialty Mental Health Services and medical necessity criteria as defined by California Code of Regulations (CCR) Title IX , Article 2, Section 1830.205.
Please visit our career page at www.beaconhealthstrategies.com to apply