Remote Behavioral Medical Director, Full-Time

About the Role

Serve as a clinical leader within the Medical Management/Health Services team, supporting medical management, quality improvement, and credentialing functions. Provide medical oversight for utilization management, cost containment, and quality initiatives, ensuring timely and effective decision-making on complex medical services.

Responsibilities

• Assist in developing goals and policies to enhance care quality and cost-efficiency.
• Contribute to the operation of quality improvement and utilization management programs in compliance with regulatory standards.
• Participate in physician committees, provider network development, and market expansion efforts.
• Conduct rounds to assess and coordinate care for high-risk patients, collaborating with care teams.
• Review complex claims and medical necessity determinations, and evaluate utilization trends and practice patterns.
• Develop provider relationships and implement clinical recommendations to improve utilization and quality.
• Support physician education on clinical issues and policies.
• Identify clinical studies aimed at reducing unwarranted practice variation.
• Represent the organization on medical policy issues at various committees and forums.

Qualifications

• Medical Doctor or Doctor of Osteopathy with active medical practice.
• Board certification by the American Board of Psychiatry and Neurology; Child Psychiatry certification preferred.
• Utilization management experience and knowledge of accreditation standards are preferred.
• Current unrestricted state license; experience with diverse populations is a plus.

Skills

• Strong collaboration, review, and clinical decision-making skills.