Job Details

PART-TIME PSYCHIATRY CONSULTANT

ASSOCIATE MEDICAL DIRECTOR-DWIHN PIHP/CMHSP

Under the supervision of the Chief Medical Officer (CMO), the Psychiatrist will help develop Evidence Based Best Practice Standards for service delivery and perform other clinical duties and activities as directed.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

· Develops Evidenced Based Best Practice Standards for service delivery.

· Provides oversight for the following: utilization management/review; Credentialing, denial of services, appeals; retrospective reviews; reporting and review of deaths; Recipient Rights reviews, reporting and review of critical and sentinel events; and clinical aspects of grievances and Medicaid Fair Hearings.

· Determine medical necessity and conducts peer review which can include consultations with contractors and service providers.

· Oversees policy development.

· Research medical topics such as psychotropic medication, psychiatric evaluation, and coordination of care, etc. Engage in publication opportunities.

· Supervise coordination of care activities.

· Meets and coordinates with Medicaid Health Plans (MHP) to facilitate integration of services.

· Work on plans to improve Quality indicators and develop quality improvement plans as needed.

· Provide training specific to the application of medical necessity criteria for all referrals to the Network’s program for comprehensive mental health services.

· Conducts staff development and training for Medical Directors, providers, Network staff, and other professional staff.

· Serves in a leadership capacity for the following committees: Medical Advisory, Utilization Management, Peer Review, Sentinel Events, Death Review, Behavioral Treatment Advisory Committee, Credentialing Committee and others as required or directed by the Chief Medical Officer.

· Provide consultation on cases in Emergency Department, Inpatient psychiatric units, State hospitals or those receiving services through our providers.

· Provides clinical reviews for all cases requiring psychiatric consultation for the Recipient Rights office.

· Teaches students, Psychiatric residents and fellows.

· Participates in clinical and administrative meetings as directed by CMO.

· Oversees the extended length of stays, long-term hospital transfers, discharge planning and annual community hospital surveys.

· Participates in Quality Assurance reviews. Work closely with Quality Department with goal of continuous quality improvement of services delivered to the members as well as internal quality improvement of the organization.

· Analyzes and evaluates patient data and work on reports and presentations.

· Provide consultations for Disability Designation of members.

· Review Eligibility assessments for members contacting the Access Center as needed.

· Provide clinical coverage and consultation on any urgent clinical issue that may arise between the time that members contact Access center and until they are seen by our Clinically Responsible Service Providers.

· Participate in call coverage schedule as assigned.

· Performs related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

· Knowledge and experience with the Accreditation and Certification Standards such as NCQA, Joint Commission.

· Knowledge of DWIHN policies, procedures and practices.

· Knowledge of the DWIHN provider network and community resources.

· Knowledge of the Michigan Mental Health Code.

· Knowledge of MDHHS policies, rules, regulations and procedures.

· Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.

· Knowledge of the clinical care process (screening, assessment, treatment planning, case management, and continuing care).

· Knowledge of and ability to use screening and assessment tools for behavioral health services.

· Knowledge of medical and behavioral health practices and terminology.

· Knowledge of compliance standards.

· Knowledge of Medical Necessity Criteria for Behavioral Health Services.

· Knowledge of documents / regulations that govern the provision of mental health services, e.g., Medicaid Manual Mental Health and Substance Abuse Chapter III, State Plan for Medicaid, Michigan Department of Health and Human Services Quality Plan, BBA requirements and the Mental Health Code.

· Knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis.

· Knowledge of diagnostics, psychopharmacology, and supportive treatment approaches as applied to a severely mentally ill (SMI) adults, Children with Serious Emotional Disturbances (SED), Individuals with Intellectual Disability (IDD) as well as our Substance Use Disorder (SUD) population.

· Knowledge of the identification and treatment of co-occurring mental health and substance use disorders.

· Knowledge of psychotropic medications.

· Knowledge of Community Mental Health Services Programs (CMHSP) and Prepaid Inpatient Health Plans (PIHP)

· Knowledge of community mental health services and resources.

· Knowledge of the DSM Statistical Manual.

· Leadership skills.

· Training skills.

· Assessment and evaluation skills.

· Organizational skills.

· Planning skills.

· Analytical skills.

· Report writing skills.

· Decision Making skills.

· Critical Thinking skills. · Interpersonal skills.

· Communication skills.

· Teaching skills.

· Written communication skills.

· Computer skills (Word, Excel, Access, Power Point, Outlook, Teams) · Teamwork Skills.

· Ability to communicate orally.

· Ability to communicate in writing.

· Ability to work effectively with others.

· Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.

REQUIRED EDUCATION:

A Medical Degree from an accredited School of Medicine.

Board Certification in Psychiatry.

Additional Board certification in Child and Adolescent Psychiatry is preferred.

REQUIRED EXPERIENCE:

1 years of administrative experience in a Mental Health Program with experience in the following areas:

· Policy writing

· Accreditation activities

· Staff development

· Peer review management of direct report staff

REQUIRED LICENSE(S).

· A valid and current Michigan License to practice as a physician.

· A valid and current Michigan controlled substance license.

· Valid and current Drug Enforcement Agency Registration.

· A valid State of Michigan Driver’s License with a safe and acceptable driving record.

WORKING CONDITIONS:

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan.

This description is not intended to be a complete statement of job content, rather to act as the essential functions performed. Management retains the discretion to add or change the position at any time.