job

The Chief Psychiatric Medical Officer (CPMO) is the leader for mental health/behavioral health within Health Services for Children with Special Needs, Inc (HSCSN). HSCSN is a small, Medicaid Managed Care Organization (health plan) that is contracted with the District of Columbia to administer the Child and Adolescent Supplemental Security Income Program (CASSIP). Medicaid enrollees are eligible for CASSIP if they are between 0 and 26 years and have Supplemental Security Income (SSI) or are considered SSI-eligible. HSCSN is an integrated health plan, providing both physical health and behavioral health services. HSCSN is part of the HSC Health Care System.

The CPMO must be a psychiatrist who is board-certified in Child and Adolescent Psychiatry and licensed to practice medicine in the District of Columbia. CPMO responsibilities parallel those of the Chief Medical Officer (CMO) with respect to enrollees with behavioral health conditions, mental illness, or substance abuse disorders. The CPMO participates in organization-wide strategic, medical and business planning as well as goal setting related to mental/behavioral health. Works as clinical leader for behavioral health services for the four clinical departments, i.e. Medical Affairs, Care Management (CM), Utilization Management (UM), and Quality Management. Works with UM and CM staff to ensure that HSCSN enrollees receive medically appropriate, timely, effective and coordinated heath care services to address mental/behavioral health needs. Collaborates with the CMO, CQO, Quality Management staff and Care Management Department to monitor and evaluate the quality of behavioral health services being delivered to HSCSN members by network mental/behavioral health providers. As an executive of HSCSN, serves as a leader and clinical liaison with HSCSN network mental health providers and communicates with behavioral health agencies and regulatory entities on behalf of HSCSN.

Minimum Education
Medical Doctor (M.D.) (Required)
————————————————————————————————–

Minimum Work Experience
3 years At least three years of clinical practice as a child and adolescent psychiatrist
Work experience with a managed care organization is preferred.
(Required)——————————————-

Required Skills/Knowledge
Familiarity with Medicaid system.
Experience with SSI eligible population.
Expertise in residential treatment for youth.
Multidisciplinary team leadership.
—————————————————————————————–

Required Licenses and Certifications
Must be a physician with a current license to practice medicine without restriction in the District of Columbia.
Must be board certified in Child & Adolescent Psychiatry.
(Required) Board Certification in Child and Adolescent Psychiatry (Required)

Job Functions

Essential job duties:

• Leads and manages HSCSN’s mental/behavioral health activities and clinical programs.

• Monitors ongoing mental/behavioral health activities and clinical service delivery by the HSCSN provider network.

• Provides guidance and supervision in the development of HSCSN protocols, policies and procedures pertinent to mental/behavioral operations.

• Advises care management staff related to behavioral health diagnoses, services, and care coordination.

• Holds regular Behavioral Health Rounds with medical management staff to address behavioral health concerns of individual enrollees.

• Advises utilization management staff about appropriate authorizations and protocols and participates in the development of guidelines delegating the authorization of certain mental/behavioral health benefits.

• Provides second-level review for the Utilization Management Department related to pre-service, concurrent, and post-service authorization decisions for behavioral health services. Provides second-level review for all adverse benefit determinations related to behavioral health services.

• Ensures HSCSN enrollee medical records are reviewed when staff express concerns related to mental/behavioral health care involving clinical appropriateness, quality of care and service, effectiveness of outcomes, potential provider fraud/abuse, provider competency, etc.

• Oversees and coordinates the credentialing of physicians and other mental/behavioral health care providers and entities.

• Participates as a leader in preparation for and during actual accreditation surveys and regulatory agency audits (e.g. JCAHO, NCQA, DelmarvaQlarant, Medicaid, HCFACenters for Medicare & Medicaid, DC DHCF, DC DCRA, DC DISB, etc.)

• Participates in education of the Network mental/behavioral health providers as it relates to the unique mental/behavioral health needs of children/youth, current trends in the care of this population and ways of improving care and services.

• Serves as liaison between enrollees and the network mental/behavioral health providers when necessary.

• Participates in the design of data sets and control measures that provide information essential for effective quality management of mental/behavioral health services.

• Provides input into new and renegotiated mental/behavioral health providers contracts.

• Represents HSCSN leadership, board of directors, HSCSN mission, values and goals to Network mental/behavioral health providers.

• Is available to perform his/her function during normal business hours and accessible via HSCSN cell phone 24/7 (when not on PTO), to respond to all attempts to contact him/her in a timely manner for urgent /emergent business matters.

• Participates in peer to peer discussions with relevant physicians as necessary.

• Assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives and practitioner/provider credentialing.

• Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes.

• Serves as the chair of the Residential Placement Committee. Participates as a member of the committee in decisions relating to placement of patients in residential treatment facilities.

• Serves as a Co-Chair of the Benefits & Utilization Management Committee (BUMC) and the Credentialing Committee, as a member of the Quality Management Oversight Committee, Appeals & Grievances Committee, Enrollee Safety/Risk Management Committee, and various other HSCSN and DHCF Committees as appropriate.

Other job duties:

• May perform other duties in addition to those outlined in this job description.

DC Residents Encouraged to Apply

Primary Location

 District of Columbia-Washington

Work Location

Job

 Physicians / Physicians Leadership

Organization

 HSC W/Special Needs

Position Status R (Regular) – FT – Full-Time

Job Posting

 Apr 25, 2025, 4:31:10 PM

Full-Time Salary Range

 150000 – 450000