Medical Director – Behavioral Health

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

📋 Description

• This role supports the clinical objectives for the health plan(s) across all business lines (Medicaid, Medicare, and Commercial) and executes programs to realize this vision.

• Offers clinical leadership to the interdisciplinary Medical Management team, which encompasses clinical/medical oversight of team members and provides consultation and training for care managers to enhance cost and quality of care.

• Oversees physicians on a day-to-day basis for an assigned interdisciplinary Utilization Management (UM) team, engaging regularly in the case management of at-risk patients and making medical necessity determinations.

• Tracks high-risk cases throughout the treatment continuum, which includes inpatient, rehabilitation, partial hospitalization, outpatient, and various other levels of care.

• Ensures individuals with severe, complex, and/or treatment-resistant conditions receive medically necessary coordinated care throughout their treatment episode.

• Develops and implements a Utilization Management program and action plan that includes strategies to guarantee high-quality patient care, ensuring that patients receive the most suitable care in the most cost-effective environment.

⛳️ Requirements

• Doctor of Medicine (MD) degree OR Doctor of Osteopathic Medicine (DO) degree OR Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with successful completion of a United States-based internship and residency (and successful completion of a United States-based fellowship for subspecialists).

• Successful completion of the ECFMG and FLEX examinations.

• Full training in a residency program in the United States or Canada accredited by the Accreditation Council for Graduate Medical Education (ACGME).

• A minimum of 3 years of post-residency experience that includes substantial direct patient care at multiple levels of care.

• Clinical experience relevant to the patient populations being managed.

• Unrestricted current and valid medical license or certification to practice in a state or territory of the United States.

• Capability and willingness to lead and implement necessary changes.

• Experience in cost-benefit analysis, medical decision analysis, credentialing, quality assurance, and continuous quality improvement (CQI) processes.

• Availability for after-hours coverage may be required.

🏝️ Benefits

• Comprehensive benefits package

• Health insurance

• Life insurance

• Voluntary benefits

• Wellness programs