Behavioral Health Medical Director

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

📋 Description

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

• Offer medical leadership in utilization management, cost control, and initiatives for medical quality improvement.

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

• Aid in performance improvement initiatives for capitated providers.

• Assist in planning objectives and policies to enhance quality and cost-effectiveness of care.

• Provide medical expertise for quality improvement and utilization management programs adhering to regulatory, state, corporate, and accreditation standards.

• Support physician committees in terms of structure, processes, and membership.

• Carry out regular rounds for high-risk patients and collaborate with care management teams.

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

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

• Assist with physician education regarding clinical issues and policies.

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

• Identify clinical quality improvement initiatives aimed at reducing unwarranted variations in clinical practice.

• Interface with physicians and providers to implement recommendations for enhancing utilization and healthcare quality.

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

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

• Represent the business unit before public audiences and at state or ad hoc committees as required.

⛳️ Requirements

• Must possess Board Certification as a Psychiatrist.

• Must hold a valid license in California, Oregon, Washington, or Nevada.

• Highly preferred to reside in the Pacific Time Zone.

• Medical Doctor or Doctor of Osteopathy degree required.

• 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.

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

• Must actively engage in the practice of medicine.

• 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.

• Availability to work weekends and holidays as necessary may be required.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Additional incentive options may be included in total compensation.

• Equal opportunity employer dedicated to diversity.