Medical Director – Behavioral Health

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

📋 Description

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

• Handle high-risk patient cases and make determinations regarding medical necessity.

• Deliver comprehensive behavioral health care management, aimed at ensuring quality care and enhancing operational effectiveness.

• Engage in the appeals process, including examining adverse incidents and addressing quality of care issues.

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

• Aid in the creation, execution, monitoring, and assessment of the utilization management program and its action plans.

• Support the development, implementation, and interpretation of medical policies, medical necessity criteria, clinical practice guidelines, and new technology evaluations.

• Contribute to the creation, execution, and assessment of clinical and medical initiatives.

• Collaborate with behavioral health professionals regarding patients with severe, complex, or treatment-resistant conditions.

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

• Provide psychiatric leadership for clinical quality improvement activities that comply with NCQA standards.

• Take part in triage and referral processes for care management.

• Offer weekend coverage approximately every 6–7 weeks.

• Carry out additional duties as necessary.

⛳️ Requirements

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

• Active state medical license without any encumbrances.

• Capability to obtain licenses in additional states.

• Ability to acquire additional state licenses and provide utilization management services across various state health plans.

• At least 5 years of clinical practice experience in the healthcare delivery system as a psychiatrist.

• Familiarity with managed care, including experience as a provider and in care utilization review or physician advisory roles.

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

• Child/Adolescent Board Certification is preferred.

• Ideal candidates should reside in Ohio.

🏝️ Benefits

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

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.