Associate Medical Director, Psychiatry - PCHP (Hybrid)
Company: Parkland Health and Hospital System
Location: Dallas
Posted on: May 19, 2025
Job Description:
Are you looking for a career that offers both purpose and the
opportunity for growth? Parkland Community Health Plan (PCHP) is a
proud member of the Parkland Health family. - PCHP is a Medicaid
Managed Care Organization servicing Texas Medicaid and CHIP in the
Dallas Service Area. - PCHP works to fulfill of our mission by
empowering members to live healthier lives. - By joining PCHP, you
become part of a team focused on innovation, person-centered care,
and fostering stronger communities. As we continue to expand our
services, we offer opportunities for you to grow in your career
while making a meaningful impact. Join us and work alongside a
talented team where healthcare is more than just a job-it's a
passion to serve and improve lives every day. - -Primary
PurposeOversees medical coordination required for effective
utilization and quality management of the health plan network.
Supports the clinical activities of PCHP Utilization Management,
Quality Management, Clinical Policy, Technology Assessment,
Credentialing, Population Health and Fraud, Waste and Abuse
Functions to assure comprehensive, high quality health care to plan
members in accordance with managed care and PCHP policies. Monitors
clinical care needed to produce optimal health outcomes and
cost-effective care. -Education
Must have successfully completed an
Accreditation Council for Graduate Medical Education (ACGME) or
American Medical Association (AMA) approved residency in an
appropriate specialty to the PCHP population.Master's degree in
business administration, healthcare administration, or a related
discipline preferred. -Experience
At least five (5) years of clinical
practice experience in a specialty relevant to the care of PCHP
members.Experience in the development of medical policies,
procedures and programs is preferred.Qualifications to perform
clinical oversight for the services provided by the health plan to
include but not limited to education, training, or professional
experience in medical or clinical practice preferred.Past
participation in a managed care UM committee preferred.Peer Review,
medical policy/procedure development experience
preferred.Experience in Utilization/Quality Program management
preferred. -Certification/Registration/Licensure
Must be currently licensed for the
practice of medicine in the State of Texas.Must meet and maintain
licensing and registration requirements as required by the State of
Texas for Managed Care Medical Directors.Board certification in the
relevant specialty preferred -Skills or Special Abilities
- Excellent verbal and written
communication skills including the ability to communicate
effectively and professionally across disciplines and with a
variety of constituents as well as the ability to articulate
complex information in understandable terms.Working knowledge of
managed care principles and Texas Medicaid Regulations is
preferred.Must understand and demonstrate knowledge of principles
of care coordination and collaboration, population health and
social determinants of health, clinical evaluation of
evidence-based care and value-based purchasing.Must be familiar
with the role of pharmacy and behavioral health in managing health
care.Ability to apply medical knowledge and principles to business
challenges in order to achieve significant member, business, and
quality outcomes.Demonstrated ability to coach and influence for
results.Strong interpersonal and conflict resolution skills with
the ability to establish and maintain effective working
relationships with diverse groups across and beyond the
organization.Strategic thinking and long-range planning skills with
the ability to lead major organizational initiatives, accomplish
results, and achieve measurable outcomes or goals.Ability to work
in challenging situations involving competing interests, and high
level-interdisciplinary groups.Excellent time management and
organizational skills with the ability to manage multiple demands
and respond to rapidly changing priorities.Strong analytical and
problem-solving skills.Knowledge of Texas Medicaid (STAR, STAR
Kids/CHIP) program, National Committee for Quality Assurance
(NCQA), the Uniformed Managed Care Contract, and the Uniform
Managed Care Manual.Sound business acumen.Proficient Microsoft
Office and computer skills. -ResponsibilitiesOperationsReviews
prior authorization, concurrent, and pre-service and post-service
appeals request for medical necessity and resolves grievances
related to medical quality of care.Participates in identification
and analysis of process improvement of jobs design, work processes,
and workflows for the clinical area and implements appropriate
changes to improve effectiveness, productivity, and efficiency that
support the overall goals of the managed care delivery system and
PCHP.
- Facilitates conformance to Medicaid, NCQA and other regulatory
requirements.
- Provides clinical oversight for utilization management, disease
management and quality management activities as assigned by the
PCHP Chief Medical Officer or Medical Director including
participation in development of medical policies and procedures for
coverage and authorization and clinical standards and guidelines
based on evidence-based medicine.
- As assigned by the Chief Medical Officer or Medical Director,
serves as chairperson or member of managed care committees, and
participates on various community and interdisciplinary
committees.
- Performs peer to peer calls as necessary to support the
utilization management process.StrategyAssists the Chief Medical
Officer or Medical Director in oversight, evaluation, and
administration of the clinical aspects of PCHP fraud, waste, and
abuse programs.Assists the Chief Medical Officer or the Medical
Director and the Pharmacy Director of PCHP in overseeing and
administering the pharmacy benefit for PCHP members including
coordination of care between the Medical and Pharmacy
benefits.
- Analyzes data to establish health care provider profiles and
define acceptability of physician performance and evaluates the
effectiveness of UM practices by actively monitoring for over and
under-utilization.
- Participates in development, implementation, and monitoring of
annual goals and objectives for PCHP that support the mission and
objectives of Parkland.
- Participates in assessment of existing education programs
offered to providers and members, developing, and evaluating such
programs, and provides implementation support for Quality
Improvement activities.QualityIntegrate health literacy principles
into all communication including Members and Providers.Support
strategies that meet clinical, quality and network improvement
goals.Promote the use of Health Information Technology to support
and monitor the effectiveness of health and social interventions
and make data-driven recommendations as needed.
- For staff in clinical roles, foster collaborative relationships
with members and/or providers to promote and support evidence-based
practices and care coordination.Regulatory
- Develop processes to maintain
compliance with regulatory agencies and accrediting bodies. Ensures
operations are carried out in compliance with these regulations.
-As assigned by the Chief Medical Officer or Senior Medical
Director, assists in representing PCHP on clinical activities with
relevant State and local bodies such as the Texas Department of
Insurance, Texas Health and Human Services Commission, and Texas
Medical Association. -
- Works collaboratively with others to validate and sustain
compliance with regulatory and accreditation standards.
- Conducts routine compliance audits identifying gaps and
implementing remediation plans as necessary.
- Works collaboratively with leadership and/or PCHP Compliance to
investigate and respond to matters of concern or alleged violations
taking corrective action as necessary.
- Provides timely and accurate responses to requests for
information from regulatory agencies and accrediting bodies.Fiscal
Management and Operating Budget
- Promote activities to achieve operational efficiency.
- Consider operational outcomes and financial implications when
making recommendations to implement new programs or modify current
programs.Professional Accountability
- Acts with the highest integrity and ethical standards while
adhering to Parkland's Mission, Vision, and Values.
- Adheres to organizational policies, procedures, and
guidelines.
- Completes assigned training, self-appraisal, and annual health
requirements timely.
- Adheres to hybrid work schedule requirements.
- Attends required meetings and town halls.
- Recognizes and communicate ethical and legal concerns through
the established channels of communication. Demonstrates
accountability and responsibility by independently completing work,
including projects and assignments on time, and providing timely
responses to requests for information.
- Maintains confidentiality at all times.
- Performs other work as requested that is reasonably related to
the employee's position, qualifications, and competencies.Job
Accountabilities
- Identifies and analyzes the design of jobs, work processes,
work flows, etc. for the area and implements appropriate changes to
improve effectiveness, productivity, and efficiency that support
the overall goals of the department and Parkland.
- Stays abreast of the latest developments, advancements, and
trends in the field by attending seminars/workshops, reading
professional journals, actively participating in professional
organizations, and/or maintaining certification or licensure.
Integrates knowledge gained into current work practices.
- Maintains knowledge of applicable rules, regulations, policies,
laws and guidelines that impact the area. Develops effective
internal controls designed to promote adherence with applicable
laws, accreditation agency requirements, and federal, state, and
private health plans. Seeks advice and guidance as needed to ensure
proper understanding.
- Develops and monitors annual budgets that ensure the department
has the necessary funds to carry out the goals and objectives that
have been established for the department.
- Develops, implements, monitors, and revises annual goals and
objectives for the department that support the missions and
objectives of Parkland.
- Selects, trains, schedules, motivates, supervises, and
evaluates employees making recommendations for disciplinary actions
up to and including termination, to ensure maximum utilization of
individual and group capabilities. Ensures that assigned employees
receive opportunities to further their knowledge. - -#L1-NB1 - - -
- - - - - - - - - - -Parkland Community Health Plan (PCHP)
prohibits discrimination based on age (40 or over), race, color,
religion, sex (including pregnancy), sexual orientation, gender
identity, gender expression, genetic information, disability,
national origin, marital status, political belief, or veteran
status. -
Keywords: Parkland Health and Hospital System, McKinney , Associate Medical Director, Psychiatry - PCHP (Hybrid), Executive , Dallas, Texas
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