Program Integrity Director Jobs in Williamstown, NJ

Position Overview: 

The Physician Advisor provides strategic oversight of medical necessity determinations for behavioral health services, ensuring alignment with clinical standards and organizational objectives. This role is accountable for conducting medical necessity and peer reviews, directing the activities of the crisis team, and fostering collaboration with clinical providers to promote high-quality, effective mental health care for CBH Members.

Essential Functions:

• Review cases from multiple sites and levels of care for medical necessity. 
• Peer review cases for disputed levels of care. 
• Perform medical reviews
• Make denial decisions based on medical necessity
• Participate in clinical and administrative meetings.
• Interact with providers on clinical and administrative matters.
• Serve as clinical leadership resource and consultant to Clinical Care Managers, offering guidance on complex cases and best practices.

Position Requirements:

Education: 

• MD/DO from Accredited Medical School

License/Certification: 

• Current Board certification in Psychiatry and/or Child and Adolescent Psychiatry by the American Board of Psychiatry and Neurology; Current and Active State of Pennsylvania Medical License

Relevant Work Experience: 

• Minimum of 5 years of clinical psychiatry experience including significant and specific experience with inpatient care and substance abuse treatment

Skills:

• Ability to provide clinical oversight on a wide array of operational activities.
• Strategic planning
• Financial planning
• Excellent written and verbal communication skills
• Familiarity with medical assistance regulations and managed care principles and practices
• Knowledge of Managed Care Organization operations and principles.
• Demonstrated leadership ability.

Core Expectations:

Community Behavioral Health (CBH) will hold each employee accountable for the following expectations, which align with our mission, vision, and corporate code of conduct.

• Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
• Serve as a role model by exemplifying professional behavior, language, skills, and attire to promptly and accurately serve the needs of stakeholders, members, and their families.
• Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner.
• Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality, dignity and rights.
• Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
• Actively participate in required meetings and complete all mandatory trainings.
• Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.
• Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste or abuse.

Core Competencies:

• Teamwork and Collaboration: Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables.  Encourage unity and help remove barriers to productivity and success.
• Respect: Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.
• Member Centric: Focus on the needs of our members by providing value-added services, promoting strong relationships and going beyond basic expectations to achieve the best possible outcomes.
• Honesty and Integrity: Be open and honest in all we do. Always maintain the highest level of integrity.  
• Commitment to Service Excellence:  Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service and high quality, innovative programs.
• Compassion and Empathy: Demonstrate a deep appreciation for another’s situation and point of view.     Pay attention to emotional cues, listen effectively and show an exceptional care about each person’s perspectives and circumstances.
• Problem Solving: Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints and CBH values into consideration.
• Initiative and Self-Directed:   Proactively manage time and resources in a way that ensures that all work is done in the most efficient manner while identifying and implementing initiatives without interventions from co-workers, supervisors or stakeholders.
• Flexibility and Adaptability: Adjust approaches and behaviors in order to meet the constantly changing environment head-on and accomplish CBH and individual goals.  Strive to adapt to, accept and embrace change within areas of responsibility.
• Communication: Effectively and appropriately share thoughts, ideas and information - both written and oral.  Respectfully listen to co-workers and stakeholders to gain a full understanding of issues/situations.  

• Strategic Thinking: Understand and integrate the long-term vision of CBH and focus current activities on what is critical to achieve future success including formulating objectives/priorities and developing and implementing breakthrough ideas.
• Leadership: Effectively manage and guide efforts to address challenges and drive continuous improvement for CBH’s programs, services and processes.  Develop and implement effective strategies and appropriate interpersonal styles to influence and guide others. 
• Employee Development: Recognize and promote the necessity to hire, assess, develop and retain high quality talent.  Acknowledge strengths and weaknesses in team members through an ongoing performance management process that provides timely feedback in order to help them develop and enhance performance.

CBH Requirements and Accommodations:

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement: 

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:  

We strive to promote and sustain a culture of diversity, inclusion, and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting Accommodation:

CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodation made to facilitate the recruiting process is not a guarantee of future or continued accommodation once hired.

If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov