Health Underwriting Director jobs in Sumter, SC

Leadership Duties and Responsibilities:

• Provides clinical supervision, leadership and support to all Behavioral Health Providers.
• Works collaboratively with the Chief Medical Officer in monitoring the performance of the EMR system.
• Leads and maintains an effective quality improvement/quality assurance program for Behavioral Health and, when required, assists in moving to the next level (NCQA/PCMH).
• Assist the appropriate staff in the solicitation, development, management and evaluation of any grants deemed necessary and useful to the function of Tandem Health's Behavioral Health services. Provides input for grant reports as necessary.
• Reviews and makes recommendations for content in individual Practice Agreements for Advanced Practice Providers (i.e. Nurse Practitioners and Physician Assistants).
• Monitors Provider office and phone call schedules, as well as client appointments and staffing patterns to ensure services are responsive and will ultimately provide optimal outcomes.
• Participates in educational events in the community and at Tandem Health to increase awareness of health-related issues.
• Works with the Chief Clinical Officer to investigate and resolve Behavioral Health patient grievances regarding clinical quality of care.
• Fosters and supports linkages with appropriate specialists, sub-specialists and related services.
• Demonstrates professional interactions with internal and external customers and stakeholders.
• Establishes and maintains effective working relationships with individuals of various cultural, ethnic, and socioeconomic backgrounds.
• Participates in initiatives and concerns involving patient safety, quality, infection control, risk management and patient service, especially those related to Providers.
• Leads the Behavioral Health team's participation in Tandem Health's Continuous Performance Improvement (“CPI”) Plan and other clinical quality activities for improving the quality of patient care, including but not limited to overseeing the Behavioral Health peer review process and compliance with clinical measures; makes recommendations for continuing education opportunities and requests for Behavioral Health Providers.
• Reports on progress of goals and other relevant data at the Tandem Health Provider/CPI/Rx P&T Quarterly Meetings.
• Participates as a member of Tandem Health's Medical Privileging Review Committee.
• Works with Human Resources in the recruitment, selection, and retention of highly qualified and skilled Physicians and Advanced Practice Providers.
• Manages the orientation and training of Behavioral Health Provider hires.
• Provides coaching and performance feedback to Behavioral Health Providers utilizing Tandem Health-approved performance feedback tools and methods, ensuring completion of performance appraisals in a timely fashion.

Clinical Duties and Responsibilities:

• Provides direct, clinically competent, medical care in an ambulatory setting that includes examinations, evaluations, diagnoses, treatment, follow-up, consultations, and health education for patients within scope of expertise and in accordance with the appropriate organizations.
  

• Prescribes and/or administers recommended therapies, medications and other specialized medical care to treat or prevent illness, disease, or injury, to include referring clients to specialists and/or other medical providers, as necessary/appropriate.
• Monitors the condition and progress of all Behavioral Health and re-evaluates treatment plans as necessary and appropriate.
• Educates patients and their caregivers regarding health and illness prevention as well as recommend resources to meet their needs. 
• Instructs patients and caregivers regarding medications and treatment instructions.
• Adheres to established clinical protocols and procedures.
• Supervises or participates in patient emergencies as required.
• Participates in after-hours phone call rotation for Behavioral Health
• Performs all functions and responsibilities based upon Tandem Health's policies and procedures; guidelines of applicable board certifying entities.
• Maintains complete medical records in the established chart.
• Observes all infection control procedures.
• Follows established health center procedures for patient billing and reimbursement.
• Participates in quality assurance and other committee activities as assigned.
• Reports any discrepancies, irregularities, and/or violations involving clinical care, administrative procedure, billing issues or other protocols to the appropriate personnel.
• Maintains professional competence by completing appropriate specialty requirements of CME.
• Maintains current certifications.
• Attends required meetings and participates in committees as assigned.
• Maintains strictest confidentiality.
• Participates in professional development activities and maintains professional affiliations.
• Successfully completes Tandem Health credentialing and privileging upon hire, and re-privileging, as required.
• Fulfills HRSA and health center productivity standards.
• Participates in staff medical education programs and patient health educational activities as required.
• Performs other duties as assigned by supervisor.

Qualifications:

• M.D./D.O. licensure in the state of South Carolina
• Successful completion of a residency training program in Psychiatry
• Current board certification or board-eligible with the American Board of Psychiatry and Neurology (ABPN)

To learn more about Tandem Health and our benefits, please click the links below. 

https://tandemhealthsc.e3applicants.com/about-us/benefits-trial

https://www.youtube.com/watch?v=STg1IbibH5g