Behavioral Health Medical Director

This is a fully remote position, open to applicants in California, +3 more states.

📋 Description

• Assist the Chief Medical Director in overseeing and coordinating medical management, quality enhancement, and credentialing functions.

• Provide medical leadership for utilization management, cost reduction, and initiatives aimed at improving medical quality.

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

• Support performance enhancement initiatives for capitated providers.

• Help in setting goals and policies to enhance the quality and cost-effectiveness of care.

• Offer medical expertise for quality enhancement and utilization management programs.

• Assist with the structure, processes, and membership of physician committees.

• Perform regular rounds for high-risk patients and coordinate care with care management teams.

• Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants.

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

• Assist in educating physicians on clinical issues and relevant policies.

• Identify utilization review studies, adverse utilization trends, unusual provider behaviors, and benefit/payment adequacy.

• Identify clinical quality improvement studies aimed at minimizing unwarranted variations in clinical practices.

• Interface with physicians and providers to enhance utilization and the quality of healthcare.

• Review complex, controversial, unusual, or new-service claims to determine medical necessity and appropriate payment.

• Develop alliances with the provider community through medical management programs.

• Represent the business unit publicly and at state or ad hoc committees when necessary.

⛳️ Requirements

• Must be a Board Certified Psychiatrist.

• Licensed in California, Oregon, Washington, or Nevada.

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

• Actively practicing medicine.

• 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 is required.

• Certification in the Psychiatry specialty is mandatory.

• Current state license as an MD or DO without any restrictions, limitations, or sanctions from government programs.

• For Behavioral Health: Board certification by the American Board of Psychiatry and Neurology is required.

• Current state medical license must be free of restrictions.

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

• 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.

• Highly preferred: candidate resides in the Pacific Time Zone.

• May be required to work on weekends and holidays as necessary.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Additional forms of incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.