Behavioral Health Clinical Director Sample Clauses

Behavioral Health Clinical Director. The Behavioral Health Clinical Director must be full-time, or a combination of part-time dedicated staff to be at least a full-time equivalent, with continuous engagement to perform the functions of the Behavioral Health Clinical Director. The Behavioral Health Clinical Director(s) must be practicing within the scope of their license and hold a current unrestricted Ohio license as a Clinical Psychologist, a specialized advanced practice provider with at least two years of dedicated experience in behavioral health, or a Board-Certified Psychiatrist with a minimum of three years of professional experience in a clinical behavioral health setting. The Behavioral Health Clinical Director must have expertise in behavioral health activities and QI projects. The MCO must have a Behavioral Health Clinical Director with children's behavioral health expertise. The MCO must have at least one Board-Certified Psychiatrist, who must be a prescriber, to perform the following Behavioral Health Clinical Director functions: Play a lead role in monitoring the overall safety of members with a behavioral health, with a special focus on safe prescribing of psychotropic medications as well as all controlled substances; Have expertise in the care of individuals with substance use disorders, including the American Society of Addiction Medicine levels of care; Serve as a key clinical lead in developing and implementing evidence-based clinical policies and practices at both the MCO and the clinical practice levels. This will necessarily require the integration of relevant pharmacy and social data to inform clinical policies and practices; Participate in regulatory/accreditation reviews; and Assume key roles in quality improvement initiatives, care management activities, and member safety activities (e.g., incident management). Other duties and responsibilities of the Behavioral Health Clinical Director staff must include: Overseeing utilization management of behavioral health services to ensure members receiving timely, appropriate, and medically necessary behavioral health care in the most cost-effective setting; Engaging in oversight and quality improvement activities associated with care management activities; Providing guidance to behavioral health network development and recruitment in conjunction with provider relations, value-based contracting, support of episodes of care, and full integration of behavioral health services; Assisting in the review of utilization data to identi...
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Behavioral Health Clinical Director. The Behavioral Health Clinical Director must be full-time, or a combination of part-time dedicated staff to be at least a full-time equivalent, with continuous engagement to perform the functions of the Behavioral Health Clinical Director. The Behavioral Health Clinical Director(s) must be practicing within the scope of their license and hold a current unrestricted Ohio license as a Clinical Psychologist, a specialized advanced practice provider with at least two years of dedicated experience in behavioral health, or a Board-Certified Psychiatrist with a minimum of three years of professional experience in a clinical behavioral health setting. The Behavioral Health Clinical Director must have expertise in behavioral health activities and QI projects. The MCO must have a Behavioral Health Clinical Director with children's behavioral health expertise. The MCO must have at least one Board-Certified Psychiatrist, who must be a prescriber, to perform the following Behavioral Health Clinical Director functions:
Sample 1
Behavioral Health Clinical Director. 1. The Behavioral Health Clinical Director must be full-time, or a combination of part- time dedicated staff to be at least a full-time equivalent, with continuous engagement to perform the functions of the Behavioral Health Clinical Director.
Sample 1
Behavioral Health Clinical Director. 1. The Behavioral Health (BH) Clinical Director who possesses an independent, current, and unrestricted Ohio license to provide behavioral health services in the state of Ohio (MD, DO, RN with Advance Practice Registered Nurse [APRN] licensure, psychologist, licensed independent social worker [LISW], professional clinical counselor [LPCC], independent marriage and family therapist [LIMFT]) with a minimum of five years of experience in the provision and supervision of treatment service for mental illness and substance use disorders for children and adolescents. The BH Clinical Director must have specialty experience with children and adolescents with complex behavioral health needs, multi-system experience, and understanding of managed care.
Sample 1

Related to Behavioral Health Clinical Director

  • Behavioral Health Behavioral health services, with the exception of Medicaid Rehabilitation Option (MRO) and 1915(i) services, are a covered benefit under the Hoosier Healthwise program. The Contractor shall be responsible for managing and reimbursing all such services in accordance with the requirements in this section. In furnishing behavioral health benefits, including any applicable utilization restrictions, the Contractor shall comply with the Mental Health Parity and Additions Equity Act (MHPAEA). This includes, but is not limited to:  Ensuring medical management techniques applied to mental health or substance use disorder benefits are comparable to and applied no more stringently than the medical management techniques that are applied to medical and surgical benefits.  Ensuring compliance with MHPAEA for any benefits offered by the Contractor to members beyond those otherwise specified in this Scope of Work.  Making the criteria for medical necessity determinations for mental health or substance use disorder benefits available to any current or potential members, or contracting provider upon request.  Providing the reason for any denial of reimbursement or payment with respect to mental health or substance use disorder benefits to members.  Providing out-of-network coverage for mental health or substance use disorder benefits when made available for medical and surgical benefits. The Contractor shall assure that behavioral health services are integrated with physical care services, and that behavioral health services are provided as part of the treatment continuum of care. The Contractor shall develop protocols to:  Provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health;  Provide a written plan and evidence of ongoing, increased communication between the PMP, the Contractor and the behavioral health care provider; and  Coordinate management of utilization of behavioral health care services with MRO and 1915(i) services and services for physical health.

  • Medical Director The Contractor shall employ the services of a Medical Director who is a licensed Indiana Health Care Provider (IHCP) provider board certified in family medicine or internal medicine. If the Medical Director is not board certified in family medicine, they shall be supported by a clinical team with experience in pediatrics, behavioral health, adult medicine and obstetrics/gynecology. The Medical Director shall be dedicated full-time to the Contractor’s Indiana Medicaid product lines. The Medical Director shall oversee the development and implementation of the Contractor’s disease management, case management and care management programs; oversee the development of the Contractor’s clinical practice guidelines; review any potential quality of care problems; oversee the Contractor’s clinical management program and programs that address special needs populations; oversee health screenings; serve as the Contractor’s medical professional interface with the Contractor’s primary medical providers (PMPs) and specialty providers; and direct the Quality Management and Utilization Management programs, including, but not limited to, monitoring, corrective actions and other quality management, utilization management or program integrity activities. The Medical Director, in close coordination with other key staff, is responsible for ensuring that the medical management and quality management components of the Contractor’s operations are in compliance with the terms of the Contract. The Medical Director shall work closely with the Pharmacy Director to ensure compliance with pharmacy-related responsibilities set forth in Section 3.4. The Medical Director shall attend all OMPP quality meetings, including the Quality Strategy Committee meetings. If the Medical Director is unable to attend an OMPP quality meeting, the Medical Director shall designate a representative to take his or her place. Notwithstanding the Medical Director ‘s sending of a representative, the Medical Director shall be responsible for knowing and taking appropriate action on all agenda and action items from all OMPP quality meetings.

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. Inpatient This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. Residential Treatment Facility This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. Intermediate Care Services This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

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