Associate Medical Director, Behavioral Health

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee clinical operations and provide expert knowledge for behavioral health utilization review processes.

• Review initial cases completed by newly hired behavioral health physician reviewers and offer constructive feedback, coaching, or retraining as necessary.

• Conduct ongoing and targeted audits of behavioral health panelists based on quality trends, client complaints, overturn patterns, escalations, or other identified performance issues.

• Evaluate potential quality oversights or inappropriate determinations and deliver timely clinical feedback and corrective measures to physician reviewers.

• Assist QA and operational teams with live case escalations regarding behavioral health determinations, rationale quality, evidence-based support, peer-to-peer requirements, or reviewer performance.

• Track the effectiveness of remediation efforts and offer follow-up guidance when quality issues persist.

• Aid in the training of behavioral health reviewers and the maintenance of training standards and documentation.

• Engage in quality management and quality improvement initiatives related to behavioral health review services.

• Address client escalations or complaints concerning behavioral health physician determinations and help with root-cause analysis and corrective action plans.

• Participate in client-facing calls, audits, and meetings as the behavioral health physician subject matter expert, discussing clinical quality, reviewer performance, and necessary corrective actions.

• Join prospective client discussions, as needed, to provide a physician's perspective on behavioral health capabilities, panel oversight, and quality monitoring.

• Collaborate with Group Health leadership, Medical Director leadership, QA, operations, and physician network teams to ensure consistent, high-quality behavioral health utilization review.

⛳️ Requirements

• MD or DO with board certification in Psychiatry; certification or experience in Child and Adolescent Psychiatry is preferred.

• Valid and unrestricted medical license.

• Previous utilization review experience, ideally within a health plan, independent review organization (IRO), managed care, or a similar setting.

• Proven expertise with ASAM Criteria and behavioral health medical necessity and level-of-care assessments.

• Familiarity with behavioral health utilization management criteria and guidelines, including LOCUS/CALOCUS, MCG, and InterQual.

• Exceptional clinical judgment and the ability to assess the quality, consistency, and defensibility of physician determinations and rationales.

• Excellent written and verbal communication skills, including the capability to deliver effective feedback to physicians and engage in client-facing discussions.

• Ability to operate independently and respond swiftly to urgent clinical or quality escalations.

🏝️ Benefits

• Comprehensive health and wellness programs.

• Competitive salary and performance-based incentives.

• Opportunities for professional development and continuing education.

• Flexible work arrangements and supportive work environment.