Behavioral Health Medical Director

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

📋 Description

• Lead and oversee the daily activities of the physician utilization management team.

• Manage cases that are high-risk and make decisions regarding medical necessity.

• Deliver comprehensive behavioral health care management to ensure quality care and enhance operational efficiency.

• Engage in the appeals process, which includes investigating adverse events and quality-of-care issues.

• Offer psychiatric leadership, consultation, and training to a multidisciplinary utilization management team.

• Aid in the development, implementation, monitoring, and assessment of the utilization management program and its action plan.

• Support the creation, execution, and interpretation of medical policies, medical necessity criteria, clinical practice guidelines, and evaluations of new technologies.

• Take part in the development, implementation, and assessment of clinical and medical programs.

• Collaborate with behavioral health practitioners on complex, severe, and/or treatment-resistant conditions.

• Identify and resolve quality-of-care issues with healthcare providers.

• Lead psychiatric initiatives for NCQA-compliant clinical quality improvement activities.

• Participate in care management triage and referrals.

• Provide weekend coverage approximately every 6 to 7 weeks.

• Perform additional duties as required.

⛳️ Requirements

• Board-certified Psychiatrist currently licensed in Texas or eligible for licensure in Texas.

• Active and unencumbered state medical license.

• Capability to obtain additional state licenses and meet further state licensure requirements.

• Ability to provide utilization management support across various state health plans.

• A minimum of 5 years of clinical practice experience as a psychiatrist in the healthcare delivery sector.

• Experience in managed care, either as a provider or in roles involving care utilization review or physician advisory responsibilities.

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree.

• Board Certification in Child/Adolescent Psychiatry is preferred.

• Preference for candidates residing in Texas.

🏝️ Benefits

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness initiatives.

• Additional resources to support physical, emotional, and financial wellness.

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.