Behavioral Medical Director

This is a fully remote position, open to applicants in New Hampshire, +6 more states.

📋 Description

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

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

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

• Support performance improvement efforts for capitated providers.

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

• Provide medical insights for quality improvement and utilization management programs.

• Aid in 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 on complex cases and appeals.

• Engage in provider network development and explore new market opportunities.

• Facilitate physician education on clinical matters and policies.

• Identify opportunities for utilization review and clinical quality improvement studies.

• Analyze utilization trends, provider practice patterns, and benefit/payment components.

• Interact with physicians and providers to enhance utilization and healthcare quality.

• Review complex, controversial, unusual, or new-service claims for medical necessity and appropriate reimbursement.

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

• Represent the business unit on medical philosophy, policies, state committees, and other ad hoc committees as required.

⛳️ Requirements

• Medical Doctor or Doctor of Osteopathy degree.

• Actively engaged in practicing medicine.

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

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

• Preferred experience in Utilization Management and knowledge of quality accreditation standards.

• Certification in Child Psychiatry 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 in support of business operations, as needed.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• 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 dedicated to diversity.