Behavioral Medical Director, Central Region

This is a fully remote position, open to applicants in Iowa, +4 more states.

📋 Description

• Support the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit.

• Provide medical leadership for utilization management, cost containment, and medical quality enhancement initiatives.

• Conduct medical review activities related to utilization review, quality assurance, and the assessment of complex, controversial, or experimental medical services, ensuring prompt and high-quality decision-making.

• Facilitate the effective implementation of performance improvement initiatives for capitated providers.

• Assist the Chief Medical Director in planning and establishing objectives and policies to enhance the quality and cost-effectiveness of care and services for members.

• Offer medical expertise in the operation of approved quality improvement and utilization management programs, adhering to regulatory, state, corporate, and accreditation standards.

• Support the Chief Medical Director in the operation of physician committees, including structuring, processes, and membership.

• Conduct regular rounds to evaluate and coordinate care for high-risk patients, working alongside care management teams to optimize outcomes.

• Collaborate effectively with clinical teams, network providers, appeals teams, and medical and pharmacy consultants to review complex cases and medical necessity appeals.

• Engage in provider network development and market expansion as appropriate.

• Assist in creating and executing physician education concerning clinical issues and policies.

• Identify utilization review studies and assess adverse trends in the use of medical services, unusual provider practice patterns, and the adequacy of benefit/payment components.

• Recognize clinical quality improvement studies aimed at reducing unwarranted variations in clinical practices to enhance care quality and cost.

• Interface with physicians and other providers to facilitate the implementation of recommendations that improve utilization and healthcare quality.

• Review claims involving complex, controversial, or new services to determine medical necessity and appropriate payment.

• Build alliances with the provider community through the development and execution of medical management programs.

• May represent the business unit in various public forums both locally and nationally regarding medical philosophy, policies, and related matters as needed.

• Represent the business unit at relevant state committees and other ad hoc committees.

• May be required to work weekends and holidays as necessary to support business operations.

⛳️ Requirements

• Medical Doctor or Doctor of Osteopathy degree.

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

• Actively practicing medicine.

• Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.

• Preferred experience in treating or managing care for a culturally diverse population.

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

• Certification in Child Psychiatry is preferred.

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

🏝️ 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.