Medical Director – Psychiatry

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

📋 Description

• Conduct thorough medical necessity evaluations—prospective, concurrent, and retrospective—for a diverse array of healthcare services.

• Execute prior authorization assessments in accordance with clinical standards, regulatory guidelines, and contractual obligations.

• Facilitate peer-to-peer discussions with requesting healthcare providers, offering clinical justifications, fostering dialogue, and exploring alternative solutions.

• Issue medical necessity denials as appropriate, ensuring compliance with well-documented rationales.

• Collaborate with Nurse Practitioners, Care Coordinators, and Operations teams to enhance utilization management and improve patient outcomes.

• Assist in the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols.

• Engage in quality improvement projects, audits, and committee meetings.

• Keep meticulous documentation of review processes, decisions made, and peer-to-peer interactions.

• Stay informed about medical literature, healthcare trends, regulatory updates, and best practices in utilization management.

• Advocate for a member-centric approach while ensuring a balance between clinical effectiveness and cost efficiency.

• Adjust to the dynamic and fast-paced environment of a startup while proactively addressing challenges.

⛳️ Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical institution.

• Board Certification in Psychiatry.

• Possession of an active and unrestricted Medical License in at least one state, with the capability to secure additional state licenses as necessary.

• A minimum of 5 years of clinical practice experience.

• At least 2-3 years of experience in utilization management, medical review, or prior authorizations within an insurance or managed care setting.

• Proven track record in facilitating peer-to-peer discussions with external healthcare providers.

• Strong communication and interpersonal skills.

• In-depth knowledge of medical necessity criteria, evidence-based medicine, and principles of healthcare utilization management.

• Excellent analytical and critical thinking abilities.

• Outstanding written and verbal communication skills.

• Proficient in electronic health records (EHR) systems and utilization management software.

• Self-driven and highly organized, with the ability to effectively manage a substantial caseload in a remote working environment.

• A proactive attitude and genuine enthusiasm for contributing to a rapidly expanding and innovative startup.

• No travel is required for this position.

🏝️ Benefits

• Curative Health Plan that covers 100% of medical premiums for employees and 50% for dependents on the base plan.

• $0 copays and $0 deductibles upon completion of the Baseline Visit.

• Integrated preventive and primary care services.

• Access to mental health support.

• Personalized care navigation services.

• Chronic condition management programs for diabetes, weight issues, and hypertension.

• Support for maternity and family planning.

• 24/7/365 access to Curative Telehealth services.

• Comprehensive pharmacy benefits.

• Extensive dental and vision coverage.

• Employer-sponsored life and disability insurance, with additional supplemental options available.

• Flexible spending accounts.

• Options for flexible work arrangements, including remote and in-office opportunities.

• Generous paid time off policy along with 11 paid company holidays each year.

• 401K plan available for full-time employees.

• Up to 8–12 weeks of paid parental leave, depending on role eligibility.

• Curative will assist with additional state licensure procedures.