MD – Behavioral Health Psychiatry

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

📋 Description

• Offer daily guidance, support, and medical leadership for utilization management activities and decisions within Behavioral Health.

• Assist the Medical Director—Behavioral Health in all facets of utilization management.

• Provide medical expertise concerning health care delivery systems, utilization and reimbursement methods, and Behavioral Health treatment protocols.

• Support, guide, and consult with BH Clinician reviewers on issues or decisions related to pre-authorization, concurrent, and retrospective reviews.

• Support, guide, and consult with BH Clinician reviewers on matters concerning case management.

• Support, guide, and consult with BH Clinician reviewers on issues related to medical necessity and medical appropriateness.

• Engage in the development, planning, and management of complex cases and communicate management strategies to providers.

• Assist staff in interpreting medical policy.

• Contribute to medical policy and technology assessments and recommendations.

• Assist or provide consultation during the appeal review process.

• Offer input on provider credentialing, profiling, communication initiatives, and network development as required.

• Analyze data from diverse sources to identify trends and issues.

• Participate in internal or external committees as assigned.

⛳️ Requirements

• Board certification as an MD or DO.

• Current unrestricted license to practice medicine in a primary care specialty.

• A minimum of five years of clinical experience.

• At least three years of medical management experience in a managed care environment.

• Completion of an approved residency in Psychiatry.

• Completion of an accredited Child and Adolescent Psychiatry Fellowship.

• Child Psychology Board eligibility required by start date.

• An active unrestricted NJ MD or DO license is mandatory for Government Programs.

• Familiarity with Utilization Management principles and procedures, URAC Health UM Standards, and peer review processes.

• Strong understanding of managed care principles and concepts.

• Knowledge of the health insurance payer business, including operations.

• Extensive clinical knowledge and understanding of current healthcare issues.

• Broad clinical skills for discussing and understanding medical issues with physicians.

• Ability to exercise independent judgment in making medical necessity determinations.

• Proficient in interpreting and applying medical policy and providing guidance to others.

• Excellent communication skills.

• Analytical skills to assess data from various sources and identify trends and issues.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.