AmeriHealth Caritas Medical Director Substance Abuse Disorder Behavioral Health (New Hampshire)
Location: Manchester, NH
Primary Job Function: Medical Management
ID: 34421
Job Brief
The Medical Director Substance Use Disorder/Behavioral Health will be supporting AmeriHealth Caritas New Hampshire. Candidates must be Board Certified in Addiction Medicine in New Hampshire.
Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities.
Responsibilities:
- The Medical Director, Substance Use Disorder and Behavioral Health (Med. Dir. SUD/BH) provides organizational leadership and clinical oversight and direction for the substance use disorder (SUD) and behavioral health (BH) components of the Medical Management Programs.
- The Med. Dir. SUD/BH will have responsibility for the design of programs in compliance with federal and state laws and contractual requirements.
- At the request of BHM, this position will provide local physician review of SUD and BH treatment requests.
- The Med. Dir. SUD/BH will make recommendations regarding ACNH utilization management programs based on member and provider needs and feedback.
- The Med. Dir. SUD/BH will report to the Market President and work closely with the Chief Medical Officer, Director of Population Health, and appropriate staff to ensure compliance with state contract requirements and support evidence-based practices.
Additional Responsibilities:
- Identifying and implementing evidence-based practice guidelines throughout the provider network.
- Overseeing the quality of clinical care for network and non-network providers.
- Engaging the provider network in Continuous Quality Improvement through practice standards and an internal quality assurance program.
- Reviewing and resolving disputes related to the quality of care.
- Assuring a high-performing Utilization Management system that adheres to coverage terms and requirements.
- Serve as the primary external subject matter expert for ACNH for SUD and BH.
- Lead the development and implementation of contractually required clinical programs.
- Participate in the review of denials of care for SUD and BH treatment services.
Education/Experience:
- MD required.
- Valid NH medical license; board certification in psychiatry and addiction psychiatry preferred.
- Board Certified Addictionologist in New Hampshire.
- Must have unrestricted license to practice in the state(s) assigned.
- Must be clear of any sanctions by the applicable state or Office of the Inspector General.
- Must not be prohibited from participating in any Federally or State funded healthcare programs.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. We are committed to equity and inclusivity in our workplace.
EOE Minorities/Females/Protected Veterans/Disabled
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