Behavioral Health Medical Director

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

📋 Description

• Support the Chief Medical Director in overseeing and coordinating medical management, quality enhancement, and credentialing operations for the business unit.

• Offer medical guidance for utilization management, cost reduction, and medical quality enhancement initiatives.

• Conduct medical reviews for utilization assessments, quality assurance, and complex, controversial, or experimental medical services.

• Aid in the execution of performance improvement programs for capitated providers.

• Assist in the formulation and establishment of goals and policies aimed at enhancing quality and cost-efficiency of care and services for members.

• Provide medical knowledge in quality improvement and utilization management programs following regulatory, state, corporate, and accreditation standards.

• Collaborate with physician committees, focusing on committee structure, processes, and membership.

• Perform regular rounds to evaluate and coordinate care for high-risk patients alongside care management teams.

• Work together with clinical teams, network providers, appeals teams, and medical and pharmacy consultants on intricate cases and medical necessity appeals.

• Engage in provider network development and expansion into new markets.

• Assist in educating physicians about clinical matters and policies.

• Identify and assess utilization review studies, adverse utilization patterns, unusual provider practices, and benefit/payment adequacy.

• Recognize clinical quality improvement studies to minimize unwarranted variations in clinical practices.

• Interface with physicians and providers to enact recommendations that enhance utilization and healthcare quality.

• Review claims related to complex, controversial, unusual, or new services to ascertain medical necessity and suitable payment.

• Foster alliances with the provider community through medical management initiatives.

• Represent the business unit on medical philosophies, policies, and related matters before local and national audiences as required.

• Act as a representative of the business unit at state and ad hoc committees.

• Be available to work on weekends and holidays as necessary to support business operations.

⛳️ Requirements

• Must hold Board Certification as a Psychiatrist.

• Licensed in either California or Oregon.

• Preferably, the candidate resides in the Pacific Time Zone.

• Medical Doctor (MD) or Doctor of Osteopathy (DO) degree.

• Experience in Utilization Management and familiarity with quality accreditation standards is preferred.

• Actively engaged in the practice of medicine.

• Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.

• Experience in treating or managing care for a culturally diverse population is preferred.

• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.

• Board certification from the American Board of Psychiatry and Neurology for Behavioral Health.

• Current state medical license as an MD or DO with no restrictions, limitations, or sanctions from government programs.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off along with holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive options may be included in the overall compensation package.

• Equal opportunity employer dedicated to promoting diversity.