Medical Director – Behavioral Health

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

📋 Description

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

• Manage complex cases and make determinations regarding medical necessity.

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

• Engage in the appeals process, including the investigation of adverse events and quality-of-care issues.

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

• Support the development, implementation, monitoring, and evaluation of the utilization management program and its action plan.

• Aid in the formulation, execution, and interpretation of medical policies, including medical necessity criteria, clinical practice guidelines, and assessments of new technologies.

• Participate in the creation, execution, and assessment of clinical and medical programs.

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

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

• Provide psychiatric leadership for NCQA-compliant clinical quality improvement initiatives.

• Engage in triage and referrals for care management.

• Provide weekend coverage every 6–7 weeks.

• Perform additional duties as required.

⛳️ Requirements

• Board-certified Psychiatrist.

• Currently licensed in Louisiana or eligible for licensure in Louisiana.

• Active and current state medical license without any encumbrances.

• Capability to obtain medical licenses in other states.

• Ability to secure additional state licenses and provide utilization management coverage across various state health plans.

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

• Experience in managed care, with a focus on provider and care manager utilization review, or as a physician advisor.

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

• Child/Adolescent Board Certification is preferred.

🏝️ 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.

• Other resources supporting physical, emotional, and financial well-being.