Remote Behavioral Medical Director, Central Region

Position Purpose

Aid the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit. Provide medical leadership in utilization management, cost containment, and medical quality improvement activities.

Responsibilities

• Support the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Assist in the development and implementation of physician education with respect to clinical issues and policies.
• Identify utilization review studies and evaluate adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
• Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
• Interface with physicians and other providers to facilitate implementation of recommendations to providers that would improve utilization and healthcare quality.
• Review claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment.
• Develop alliances with the provider community through the development and implementation of medical management programs.
• Represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
• Participate in provider network development and new market expansion as appropriate.
• Represent the business unit at appropriate state committees and other ad hoc committees.
• Work weekends and holidays as needed to support business operations.

Requirements

Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred.

Qualifications

• Board certification by the American Board of Psychiatry and Neurology. Certification in Child Psychiatry, preferred.
• Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Skills

Knowledge of quality accreditation standards, experience in utilization management, and ability to collaborate with clinical teams and network providers.

Benefits

Competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Pay

$236,500.00 - $449,300.00 per year