Behavioral Health Medical Director

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

📋 Description

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

• Offer medical leadership for utilization management, cost control, and initiatives aimed at improving medical quality.

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

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

• Assist in formulating objectives and policies intended to enhance the quality and cost-effectiveness of care.

• Provide medical insight for quality improvement and utilization management initiatives.

• Support the structure, processes, and membership of physician committees.

• Carry out regular rounds to evaluate and coordinate care for high-risk patients.

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

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

• Facilitate physician education regarding clinical matters and policies.

• Identify studies related to utilization review and clinical quality improvement, and assess adverse utilization trends.

• Guide providers in implementing recommendations to enhance utilization and healthcare quality.

• Review complex claims to assess medical necessity and determine appropriate payment.

• Foster provider-community partnerships through medical management programs.

• Represent the business unit in public, state, or ad hoc committees as necessary.

⛳️ Requirements

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

• Board certification in Psychiatry.

• Board certification by the American Board of Psychiatry and Neurology.

• Current, unrestricted state medical license as an MD or DO, free of limitations or sanctions from government programs.

• Actively practicing 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 required to support business operations.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K and stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

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

• Potential for additional incentives included in total compensation.