Assistant Medical Director – Behavioral Health Focus

This is a fully remote position, open to applicants in Alaska, +1 more state.

📋 Description

• Conduct clinical evaluations of pre-service, post-service, and concurrent behavioral health services.

• Review cases related to outpatient and facility-based behavioral health.

• Collaborate with clinical personnel on specific case assessments.

• Make final coverage determinations based on medical necessity, investigational status, contractual exclusions, or network structure.

• Facilitate peer-to-peer discussions with external physicians and providers concerning denial decisions.

• Gather additional clinical history pertinent to case evaluations.

• Consult with nursing and other clinical teams to assess and explore care alternatives for members.

• Engage in the creation, annual review, and approval of company medical review criteria as a member of the Premera Medical Policy Committee.

• Partake in Inter-Rater Reliability assessments.

• Address consultation requests from Premera Blue Cross and contracted providers and facilities.

• Assist with member and provider appeals and conduct secondary reviews as necessary.

• Meet professional continuing education obligations and engage in ongoing training and education.

⛳️ Requirements

• Must be a Licensed Physician with an MD or DO degree (Required).

• Possess unrestricted Washington MD or Alaska DO state licensure, or the ability to obtain it within 90 days.

• Hold current board certification in psychiatry from the American Board of Psychiatry and Neurology.

• Have five (5) years of clinical experience in psychiatry (Required).

• Previous experience conducting medical necessity and clinical reviews in a health plan environment is preferred.

• Familiarity or experience with clinical criteria sets and pathways, such as MCG (Milliman Care Guidelines) or InterQual is preferred.

• Familiarity or experience with CPT, ICD, and HCPCS code sets and resource-based relative value scale (RBRVS) pricing concepts is preferred.

• Availability for part-time work of 20 hours per week.

🏝️ Benefits

• Medical, vision, and dental coverage with minimal employee premiums.

• Optional benefits, including pet insurance.

• Life and disability insurance.

• Retirement plans, including a 401K employer match and a pension plan vested after 3 years of service.

• Wellness incentives, offering mental well-being resources, counseling services, stress management programs, and mindfulness initiatives.

• Generous paid time off.

• Tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program.

• Flexibility for hybrid employees with access to on-site resources, networking opportunities, and team engagement.

• Commuter benefits.

• Free convenient on-site parking.

• Subsidized on-campus cafes.

• On-site health and wellness activities.

• Fitness and well-being center that offers in-person and virtual workouts and nutritional counseling.

• Shuffleboard and ping pong available on campus.