Aetna Behavioral Health Medical Director (Child & Adolescent Psychiatrist) in Phoenix, Arizona

Req ID: 44978BR

POSITION SUMMARY

The Child Medical Director (Behavioral Health) is responsible for performing daily prior authorization for medically necessary services, concurrent review of IP and residential placements, as well as Pharmacy Medical necessity reviews. There is also an opportunity to collaborate with other medical management team members and system partners and stakeholders.

Fundamental Components:

  • Prior Authorization for medically necessary services.

  • Concurrent review of inpatient hospital care and residential placements.

  • Pharmacy prior authorization for medically necessary treatments.

  • Collaboration with other health care plans and stakeholders such as the Department of Child Safety, the Department of Developmental Disabilities and the Regional Behavioral Health Authority.

    -Assist the Children's Medical Administrator with Quality Management.

    BACKGROUND/EXPERIENCE

    Three to Five years of experience in the health care delivery system e.g., clinical practice and health care industry. Managed care experience preferred.

    Demonstrated appreciation of cultural diversity and sensitivity towards target populations.

    Current Board Certification in Child and Adolescent Psychiatry and an unrestricted Arizona Medical License or willingness to obtain an Arizona License.

    EDUCATION

    The highest level of education desired for candidates in this position is a MD

    LICENSES AND CERTIFICATIONS

    Active Unrestricted Arizona State Medical License Required or willingness to get Arizona State Medical License

    Board Certification in Child & Adolescent Psychiatry Highly Desired

    Healthcare Management/ is desired

    Medical Management/ABMS - Child & Adolescent Psychiatry is desired

    FUNCTIONAL EXPERIENCES

    Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years

    Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years

    Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years

    Functional - Medical Management/Medical Management - Educator (includes in-service/1-3 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

    Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

    Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

    Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

    REQUIRED SKILLS

    Benefits Management/Interacting with Medical Professionals/ADVANCED

    Benefits Management/Shaping the Healthcare System/ADVANCED

    Benefits Management/Understanding Clinical Impacts/ADVANCED

    DESIRED SKILLS

    Benefits Management/Supporting Medical Practice/ADVANCED

    General Business/Maximizing Work Practices/ADVANCED

    Leadership/Collaborating for Results/FOUNDATION

    ADDITIONAL JOB INFORMATION

    This is an opportunity to be a part of the Children's System of Care Redesign in Maricopa County working in a progressive integrative team of medical and behavioral health experts. You will have the opportunity to directly impact the care our members receive and influence the quality of behavioral health services in Maricopa County.

    This position requires someone who is highly internally motivated and takes initiative. Must be able to work independently and be efficient with time management. Simultaneously, the candidate must demonstrate collaborative and teamwork traits- be able to clearly and effectively communicate with other clinicians, colleagues and community stakeholders. The work environment is fast-paced: candidate must be flexible. Confidence is desired; tempered by ability to absorb and incorporate feedback.

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care