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Medical Director, Behavioral Medicine - Health Alliance Plan Job

Henry Ford Health

Date: Apr 8, 2014

Location: Detroit, MI, US

Medical Director, Behavioral Medicine - Health Alliance Plan

Requisition #: 76547
Status: Full-Time with Full-Time Benefits (40 Hours)
Business Unit: Health Alliance Plan (HAP)
Shift: Days
Department: HAP DOCTORS
Weekends: No
Job Family: Managed Care
Job Function: Leadership/Management
Campus/Job Location: Health Alliance Plan (HAP) - Detroit
Location (State/City): US-MI-Detroit

More information about this position
Our health system thrives on teamwork, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you!

Henry Ford Health System is one of the country's largest health care systems and a national leader in clinical care, research and education. Our system includes the 1,200-member Henry Ford Medical Group, six hospitals, Health Alliance Plan, 32 primary care centers and many other health-related entities throughout Southeast Michigan. Founded in 1915 by auto pioneer Henry Ford, we continue to be committed to improving the health and well-being of a diverse Michigan community. In 2009 alone, Henry Ford Health System provided more than $173 million in uncompensated care. Henry Ford also is a major economic driver in Michigan and employs more than 23,000. Our health system is led by CEO Nancy Schlichting.

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General Summary:

To improve the health status of HAP members as it relates to behavioral medicine; provide clinical behavioral health leadership for the plan, lead quality behavioral health initiatives including accessibility, safety, appropriateness, efficiency, and cost-effectiveness of care. Participate in establishing and supporting policies and procedures that assure health care practices which meet appropriate consumer and health care standards; represent the plan and its interests multiple forums; provide clinical leadership for a team of psychologists/social work professionals by incorporating teamwork, understanding of latest research and innovative approaches to behavioral medicine and identifying and implementing best practices.

Principal Duties and Responsibilities:

* Provide medical direction and support for behavioral care management, including inpatient and outpatient care management.
* Oversee the utilization of behavioral health care including medical necessity decisions.

* Provide support to the member grievance area and physician/provider appeals committee, review and render decisions as appropriate.

* Provide medical direction and support for quality management and behavioral management

initiatives, including process improvements, policy development, quality committees, HEDIS, credentialing, peer reviews, clinical practice guidelines, benefit design and implementation, and the pharmacy and therapeutics committee.

* Serve as liaison between HAP and the network physicians and leadership.

* Assure quality performance adherence to clinical practice guidelines and evidence based medicine, and collaborating with other departments as needed. Accountable for the outreach and management of low performing providers.
* Meet with psychiatric medical directors.
* One-to-one collaborative conversations with physicians/providers as needed
* Analyze and share data with practitioners
* Identify opportunities for improvement for practitioners.
* Work with contracted physicians and leadership to implement processes that improve performance.

* Establish and assist in plan programs to enhance the quality of care, reduce medical costs, and achieve positive health outcomes.

* Provide 24/7 phone coverage to case managers for UM decision making.

* Coordinate and effectively manage psychiatric consultant relationships.

* Represent HAP in interactions with external customers such as hospital leadership, state and national organizations, physician groups

* Support policies and procedures to ensure regulatory compliance including but not limited to NCQA, CMS and OFIR.

* Perform other related duties as assigned.

Education Required:

* MD or DO degree
* Completion of a three year US residency
* Board Certification in psychiatry.


* Advanced degree in medical management, public health, preventive medicine, or administration.

Experience Required:

* Minimum of (7 years) of clinical practice beyond post-graduate training.
* Demonstrated commitment and understanding of population management and health status improvement.


* Minimum of three (3) years relevant management experience in health care organizations or in a managed care organization.

Certifications/Licensures Required:

* Licensed as a physician in Michigan.
* Must possess a valid Michigan driver's license

Skills and Abilities:

* Regional and State laws governing behavioral medicine
* Business acumen in Health Care, Managed Care and Psychiatry
* Understands leadership, its role and responsibilities
* Visionary
* Analytical & Reasoning ability to deal with diverse problems and people
* Problem solving and acceptable, cost effective resolutions
* Verbal and written communication is essential; Making presentations to large and small groups and interacting with people is essential
* Maintain an active clinical practice between 4-8 hours per month in the State of Michigan.
* Intermittent evening/weekend assignments required based on business needs.

HFHS and HAP Team Member Standards of Excellence:

Must meet or exceed core customer service responsibilities, standards and behaviors as summarized below:

* Display a positive attitude
* Take ownership and be accountable
* Offer open and constructive communication
* Respond in a timely manner
* Take pride in the system
* Respect and be sensitive to privacy/confidentiality
* Commit to team members
* Honor and respect diversity
* Maintain a clean and safe workplace environment

Leadership Competencies

* Leadership - Listens and communicates effectively. (Be Here Now) Coaches and mentors others. Motivates and inspires others. Has the courage to innovate. Is accessible to others. Rewards and recognizes the accomplishments of others. Demonstrates self-awareness and self-management.

* Accountability for Results and Execution - Is accountable for achieving desired results. Demonstrates confidence in decisions and executes without undue delay. Leads by example (Shadow of a Leader). Demonstrates integrity and ethical behavior. Encourages and embraces diverse cultures, ideas and opinions.

* Strategic Planning - Aligns individual/department/business unit goals and tactics with System goals. Translates strategies into goals and action plans. Keeps team informed about the strategic direction of the organization and everyone's role in achieving that vision. Eliminates silos or boundaries that impede local and System-wide strategy development, action plan implementation, and goal achievement (Systems Thinking).

* Member/Customer Focus - Models strong personal service excellence skills creating a "Lasting Impression" for our members and customers. Develops service skills in others, and holds others accountable to uphold the HFHS "Team Member Standards of Behavior." Creates an environment that "puts patients first by providing the quality of care and comfort we want for our families and ourselves." Seeks out and uses data from members and other customers in developing world-class processes and in continuous improvement efforts in service excellence.

* Performance Analysis and Knowledge Management - Demonstrates competence and credibility in area(s) of responsibility (i.e., technical, professional, and, if appropriate, clinical proficiency). Understands and interprets performance reports from all pillars to drive decision-making; uses data to evaluate the potential risk and returns on investment. Actively seeks and incorporates feedback and best practices from others in order to learn and improve. Shares knowledge with others to drive organizational improvement.

* Staff Focus - Creates a stimulating, rewarding and engaging work environment for team members. Puts the right people in the right role (or assigns the right tasks) at the right time. Encourages and challenges staff to take risks and be innovative. Supports and encourages the development of others; facilitates their personal growth and offers assistance. Celebrates achievements, contributions, and accomplishments. Demonstrates honesty and consistency in communications with staff. Create a collaborative culture by demonstrating a positive attitude and hopeful energy.

* Process Management and Focus on Safety - Sets expectations and targets that are aligned with system goals in the areas of member safety and quality. Seeks and practices continuous improvement of products, services and processes. Is an agent of change (e.g., challenges the status quo; suggests alternative solutions to challenging problems, supports others with change). Creates an environment where people feel "safe" to speak up and speak out about safety issues and/or inappropriate behaviors. Follows guidelines of local and System-wide quality and safety initiatives, such as the No Harm campaign. Models and strictly enforces personal safe practices (e.g., hand-washing).

Physical Demands/Working Conditions:

* Typical office environment

* Sedentary – Exerts up to 10 lbs. of force occasionally to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for periods of time.

* Talking – Expressing or exchanging ideas by means of the spoken word.

* Hearing – Perceiving the nature of sounds

* Travel – As needed.

Equal Employment Opportunity / Affirmative Action Employer

Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, national origin, sex, sexual orientation, age, disability, religion, weight/height, marital status, familial status, veteran status or any other characteristic protected by law..

Nearest Major Market: Detroit
Job Segments: Medical, Pharmacy, Public Health, Behavioral Health, Manager, Healthcare, Management