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 implementing performance improvement initiatives for capitated providers.
• Assist in planning and establishing goals and policies to enhance quality and cost-effectiveness of care and services for members.
• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
• Collaborate with clinical teams, network providers, appeals team, medical and pharmacy consultants to review complex cases and medical necessity appeals.
• Participate in provider network development and new market expansion as needed.
• Develop alliances with the provider community through the development and implementation of medical management programs.
• Represent the business unit before various publics and committees on medical philosophy, policies, and related issues.
• Review claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment.
• 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 to improve 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.

Requirements

• Medical Doctor or Doctor of Osteopathy degree.
• Utilization Management experience and knowledge of quality accreditation standards preferred.
• Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous.
• Experience treating or managing care for a culturally diverse population preferred.
• Board certification by the American Board of Psychiatry and Neurology.
• Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Qualifications

• Active practicing medicine.

Skills

• Strong medical knowledge and leadership skills.
• Excellent communication and collaboration abilities.
• Ability to manage complex medical cases and make informed decisions.
• Knowledge of healthcare regulations and accreditation standards.

Benefits

Competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, flexible work schedules, and more. 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

Schedule

Flexible work schedule with options for remote, hybrid, field, or office work.