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MD or DO degree from an accredited medical school BC/BE in Psychiatry Valid state medical license (or eligibility for licensure in Massachusetts) You are BC/BE in Psychiatry Experience or interest in managing patients with comorbid psychiatric and other medical conditions Interest in teaching, quality improvement, and program development Whether you seek cultural attractions, an intellectual environment, music and entertainment, museums, night life, shopping, fitness, food festivals, or a sunset harbor cruise- you will find it here. The city of Boston is ideally located in close proximity to the coastal beach towns of Cape Cod and the Berkshires in Western Massachusetts, the White Mountains of New Hampshire, and the Green Mountains of Vermont which offer great summertime recreational activities from swimming, sailing, fishing, hiking, and rock climbing and great winter activities from Nordic skiing to downhill skiing and snowboarding.

The Department of Psychiatry at Tufts Medical Center is seeking a dedicated and compassionate psychiatrist to join our multidisciplinary team on a 20-bed medical-psychiatry (med-psych) inpatient unit. This position offers the unique opportunity to provide comprehensive psychiatric care to patients with complex medical and behavioral health needs in a collaborative hospital setting. 
 Full-time inpatient role with shared call and teaching responsibilities 
 Provide psychiatric evaluation, diagnosis, and treatment planning for patients admitted to the med-psych unit (Pratt 2). 
 Manage acute psychiatric conditions in the context of coexisting medical issues. 
 Collaborate closely with medical and surgical consultants, nurses, social workers, and occupational therapists, to coordinate integrated care. 
 Prescribe and manage psychotropic medications and other relevant therapies. 
 Provide crisis intervention and ensure patient safety through appropriate risk assessment and management. 
 Document clinical encounters and contribute to discharge planning and follow-up recommendations. 
 MD or DO degree from an accredited medical school 
 BC/BE in Psychiatry 
 Valid state medical license (or eligibility for licensure in Massachusetts) 
 You are BC/BE in Psychiatry 
 Experience or interest in managing patients with comorbid psychiatric and other medical conditions 
 Interest in teaching, quality improvement, and program development 
 Whether you seek cultural attractions, an intellectual environment, music and entertainment, museums, night life, shopping, fitness, food festivals, or a sunset harbor cruise- you will find it here. The city of Boston is ideally located in close proximity to the coastal beach towns of Cape Cod and the Berkshires in Western Massachusetts, the White Mountains of New Hampshire, and the Green Mountains of Vermont which offer great summertime recreational activities from swimming, sailing, fishing, hiking, and rock climbing and great winter activities from Nordic skiing to downhill skiing and snowboarding. Submit an application via the apply button located at the top of the listing. Should you have any questions regarding the position or any complications submitting an application with us, please feel free to reach out to Michael Martin, Physician Executive Recruiter, at michael.

Tufts Medicine

Medical Doctor / Psychiatrist

Clinical Study Publications

Crisis Intervention

Cross-Functional

Discharge Plans

Fitness

Medical Conditions

Medications

Music

Occupational Therapy

Patient Care

Patient Safety

Psychiatry and Mental Health

Quality Management

Risk Analysis

Social Work

Surgical Nursing

Training/Teaching

Treatment Plan

Easy Hiring FTP

In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._. + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards.

Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members ESSENTIAL RESPONSIBILITIES + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise. + Participate in protocol and guidelines development to ensure consistency in the review process. + Actively manage projects and/or participate on project teams that require a physician subject matter expert. + Other duties as assigned. EDUCATION Required + Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Substitutions + None Preferred + Master's Degree in Business Administration/Management or Public Health EXPERIENCE Required + 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) Preferred + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry LICENSES AND CERTIFICATION Required + Medical Doctor or Doctor of Osteopathic Medicine (DO) + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards + Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. Preferred + None SKILLS + Critical Thinking + Case Management + Customer Service + Oral & Written Communication Skills + Collaboration + Listening + Telephone Skills + General Computer Skills + Clinical Software + Managed Care Language (Other than English) None Travel Required 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely _Disclaimer:_ _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ _Compliance Requirement_ _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ Pay Range Minimum: $170,000.00 Pay Range Maximum: $352,500.00 _Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J266916

Highmark Health

Medical Director

Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members ESSENTIAL RESPONSIBILITIES + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise. + Participate in protocol and guidelines development to ensure consistency in the review process. + Actively manage projects and/or participate on project teams that require a physician subject matter expert. + Other duties as assigned. EDUCATION Required + Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Substitutions + None Preferred + Master's Degree in Business Administration/Management or Public Health EXPERIENCE Required + 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) Preferred + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry LICENSES AND CERTIFICATION Required + Medical Doctor or Doctor of Osteopathic Medicine (DO) + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards + Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. Preferred + None SKILLS + Critical Thinking + Case Management + Customer Service + Oral & Written Communication Skills + Collaboration + Listening + Telephone Skills + General Computer Skills + Clinical Software + Managed Care Language (Other than English) None Travel Required 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely _Disclaimer:_ _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ _Compliance Requirement_ _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ Pay Range Minimum: $170,000.00 Pay Range Maximum: $352,500.00 _Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J267780

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