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

• Perform medical review activities for utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
• Ensure timely and quality decision making in medical review activities.
• Support the effective implementation of performance improvement initiatives for capitated providers.
• Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Provide medical expertise in the operation of approved quality improvement and utilization management programs in compliance with regulatory, state, corporate, and accreditation requirements.
• Assist the Chief Medical Director in the functioning of physician committees, including committee structure, processes, and membership.
• 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 appropriate.
• Develop alliances with the provider community through the development and implementation of medical management programs.
• Represent the business unit before various publics and state committees on medical philosophy, policies, and related issues.
• May be required to work weekends and holidays to support business operations.

Requirements

• Medical Doctor or Doctor of Osteopathy.
• 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. Certification in Child Psychiatry, preferred.
• Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Qualifications

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• A flexible approach to work with remote, hybrid, field or office work schedules.

Benefits

• Comprehensive benefits package including:
• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• A flexible approach to work with remote, hybrid, field or office work schedules.

Pay

$236,500.00 - $449,300.00 per year

Schedule

Flexible work schedule

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• A flexible approach to work with remote, hybrid, field or office work schedules.