Associate Behavioral Health Medical Director
Based in the United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- Minimum of 3 years of clinical practice experience in psychiatry
Requirements
- MD or DO degree from an accredited medical school.
- Completion of psychiatry residency.
- Board certification in Psychiatry.
- Active, unrestricted medical license in the United States.
- Minimum of 3 years of clinical practice experience in psychiatry.
- Experience in utilization management, medical review, or managed care.
- Strong understanding of clinical guidelines and medical necessity criteria.
- Excellent communication skills.
- MCG certification (to be obtained within 6 months of hire).
Responsibilities
- Conduct prior authorization reviews and behavioral health medical necessity determinations.
- Perform clinical appeals reviews and engage in peer-to-peer provider discussions.
- Provide clinical consultation and education to improve care quality.
- Support fraud, waste, and abuse investigations and quality-of-care reviews.
- Contribute to clinical policy and guideline development.
- Ensure compliance with CMS, NCQA, URAC, and state standards.
- Collaborate with other medical directors for cross-coverage and case escalation.
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