Psychiatrist

The Opportunity

The Community Care Services (CCS) Psychiatrist (“Psychiatrist”) ensures access to direct clinical support and services to members upon assignment and for ongoing care, in particular, the members at a Level 4 or 5 in severity. The Psychiatrist provides clinical direction to the CCS staff located in assigned areas carrying out Concurrent Reviews, as well as creating individual care plans and case management. The Psychiatrist performs initial psychiatric assessments, develops individualized treatment plans, and implements treatment for members. Being responsible for improvement of clinical outcomes and quality improvement, the Psychiatrist manages the utilization of health care resources in accordance with CCS’ objectives. In addition to monitoring relevant clinical aspects of a member’s behavioral health, the Psychiatrist assists the CCS Medical Director and CCS Executive Director in establishing new or revised policy and procedures. The integration of BH services, medical care, and pharmacy is critical to the Psychiatrist’s role. The Psychiatrist educates and informs the behavioral health community across Hawaii on the CCS program as it involves individual members, receiving and sharing suggestions on best practices and novel interventions.

Benefits: low-cost medical, dental, drug and vision insurance; paid time‑off; 401(k) employer contribution; referral bonus; pretax transportation and parking program.

Primary Duties and Responsibilities

• Works under the programmatic supervision of the CCS Medical Director, as well as the broad strategic oversight of the CCS Executive Director.
• Provides medical leadership of utilization management, cost-of-care, and medical quality improvement, prioritizing high cost and/or high utilizing CCS members.
• Performs medical review activities pertaining to health services utilization, quality improvement, as well as complex, controversial, or experimental medical services.
• Ensures timely and quality decision making, fulfilling compliance requirements and the timely needs of CCS members.
• Supports effective implementation of performance improvement initiatives for capitated providers.
• Assists CCS Medical Director in planning and establishing goals and policies to improve quality and cost effectiveness of care and service for members.
• Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
• Assists the CCS Medical Director in the functioning of the physician committees including committee structure, processes, and membership.
• Conducts regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
• Collaborates with clinical teams, network providers, pharmacists, and/or appeals-and-grievance specialist for reviewing complex and/or complicated cases.
• Participates in provider network development and new market expansion as assigned.
• Assists the CCS Medical Director in the development and implementation of physician education with respect to clinical issues and policies.
• Analyzes and evaluates adverse trends in utilization of medical services and unusual provider practice patterns.
• Gives feedback to the CCS Medical Director and CCS Director, Behavioral Health regarding the adequacy of benefit/payment components in retaining and growing the BH provider network.
• Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice to improve the quality and cost of care.
• Interfaces with physicians and other providers to facilitate implementation of recommendations to providers that would improve utilization and health care quality.
• Reviews claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment.
• Assists the CCS Medical Director or CCS Executive Director in developing strategic alliances with the provider community through the development and implementation of the medical/BH management programs.
• The Psychiatrist ensures access to direct clinical support, treatment and services to members upon assignment and for ongoing care. These services should be rendered either in office settings or in the community dependent on member needs.
• The Psychiatrist will participate in member Individualized Treatment plan (ITP) meetings when appropriate.
• Will complete Assisted Community Treatment petitions and involuntary representative payee certifications when clinically indicated.
• Represents CCS before various publics both locally and nationally on medical philosophy, policies, and related issues, as assigned.
• Represents AlohaCare’s CCS at appropriate state committees and other ad hoc committees.
• May be required to work weekends and holidays in support of business operations.
• Provides clinical oversight and guidance on Substance Use Disorder issues, including issues such as the use of ASAM or other evidence-based assessments and treatment protocols, the use of MAT, is active in teaching or training staff and, upon approval, students or professional trainees.
• Consults on AlohaCare’s clinical policy related to Substance Use Disorders and the cases of individual members for the MCM program on a routine basis.
• Attends community, State-wide, or national conferences that have been prior approved and budgeted.
• Takes part in scheduled physician coverage, including weekends, holidays, Paid-Time-Off days, travel, conferences.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Requirements

• Doctor of Medicine or Doctor of Osteopathy
• Current unrestricted Psychiatrist License in State of Hawaii.
• Active Board Certification in the area of Psychiatry.
• Minimum of 5 years of experience in psychiatric clinical practice
• Minimum of 3 years of experience or familiarity with individual care plan administration and care.
• Experience in medical leadership of clinical services, programs, or provider organizations.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Possession of a current valid Hawaii driver’s license and access to an insured automobile.
• TB Clearance
• CPR Certification

Preferred Requirements

• Minimum of 3 years of experience in managed behavioral healthcare industry.
• Medicare and Medicaid experience.
• Demonstrated expertise and experience in Behavioral Health Services, including diagnosis of patients, assessment, treatment plans, and patient monitoring.
• Experience in utilization management, case management and community services is desired.
• Work evenings and weekends as needed as the need for services arises.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.