The Medical Director for Complex Case Management is responsible for providing leadership over development, evaluation, and improvement of programs supporting the behavioral health outcomes of the most complex individuals covered through Medicaid in Philadelphia. The role will involve both direct support of individual care planning for complex cases and leading strategic initiatives to improve the health outcomes of identified cohort populations with high needs. Emphasis on successful outcomes with consideration towards reducing costs and improving efficiency, grounded in population health principles, will be essential. This will include medical leadership of complex case management, design and implementation of integrated care programs serving at-risk members and coordination with community-based organizations (CBOs) involved in addressing social determinants of health (SDOH). The development and support of Community Based Care Management (CBCM) initiatives, pilots, and sustainability plans will be included in the portfolio.
The Medical Director of Complex Case Management must be committed to building a supportive and collaborative environment, encouraging teamwork at every level. This requires exemplary communication skills with both internal and external stakeholders. He/she must support the mission, vision and values of CBH and DBHIDS. He/she will serve as a leader with other stakeholders in the population health of our region.
Work with physical health managed care plans and respective network providers to improve the health outcomes of members served through the Medicaid treatment system.
Oversee internal and external integrated care strategies within the network.
Provide medical leadership for the case management program.
Participate in complex case reviews including interagency meetings, case conferences, and red flag meetings, and utilization reviews
Participate in decisions around utilization management and network management efforts with the goal of improving prioritized population health outcomes.
Utilize available data to develop strategies to improve clinical outcomes and identify opportunities for improvement in current practices. Work collaboratively with Clinical, Quality, and Provider Relations to implement work plan strategies and educate employees and providers.
Participate in development of quality and outcomes measures to determine efficacy of services in conjunction with the quality department.
Ensure outcomes of initiatives are aligned with the triple aim, DBHIDS strategic goals, state and federally required measures and best practice.
Oversee the data analysis of complex care cohorts.
Develop and implement protocols, with other members of the clinical team, to address populations who are at risk or who may become at risk for high cost/high utilization services including identification and standardization of individual case referrals from utilization review teams
Consult with internal and external clinical teams around populations/members who present as high risk and in need of interventions, either individually or as a population.
Participate in related committees and clinical integration activities to support coordination of care across the continuum.
Represent CBH Medical Affairs in external stakeholder meetings and committees working on cross system’s collaborations and initiatives.
Work with providers and other stakeholders to engage them related to management of population cohorts, using best practices and EBPs as appropriate.
Provide updates on initiatives to Medical Affairs and Clinical Leadership
Education: graduated from accredited Medical School
License/Certification: State license in the Commonwealth of Pennsylvania, DO/MD; Board certified in Psychiatry by the American Board of Psychiatry and Neurology; \Qualified applicants with other advanced degrees and/or board certifications, and relevant experience may be consider at the discretion of the Deputy Chief Medical Officer or Chief Medical Officer
Relevant Work Experience: Minimum of 5 years of experience in behavioral health with a minimum of 2 years of leadership experience; experience with complex behavioral, physical, and social determinant aspects of health preferred
Problem solving and strong analytical skills
Excellent interpersonal skills
Flexibility in assessing situations and evaluating needs
Proficient in Microsoft Word and Excel
Ability to understand and use data and other analytic tools to evaluate programs
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