Medical Director (Behavioral Health)
United States, Mountain Time zoneFull-TimeDirector
Salary$200,280 - $360,500 / year
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Job Details
- Experience
- Post-residency experience of at least 3 years
Requirements
- Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or MBBS degree.
- Board Certified (ABMS or Specialty Board).
- Completion of a residency program in the US or Canada approved by the ACGME.
- At least 3 years of post-residency clinical experience involving substantial direct patient care.
- Valid and unrestricted medical license in the state of Idaho (plus residence state if different).
- Successful completion of ECFMG and FLEX examinations.
- Clinical experience pertinent to managed patient populations.
- Experience with cost-benefit analysis, medical decision analysis, and quality assurance processes.
- Ability to work Mountain Time zone hours.
- Willingness to provide after-hours coverage as needed.
Responsibilities
- Provide clinical leadership and medical oversight to the interdisciplinary Medical Management team.
- Perform clinical case management, including review of high-risk cases and medical necessity decisions.
- Develop and implement utilization management programs to ensure cost-effective and high-quality patient care.
- Interpret and develop medical policy, clinical practice standards, and medical necessity guidelines.
- Monitor over- and under-utilization of healthcare services and conduct peer reviews.
- Ensure compliance with NCQA, URAC, state, and federal requirements.
- Participate in quality improvement activities and investigate adverse incidents or quality concerns.
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