Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE
$217,600–$294,400 year
RemoteWashington, United States or Oregon, United States
Job Summary
Conduct Behavioral Health utilization management reviews, including prior authorizations, appeals, and post-service audits, while providing clinical expertise for case management and peer-to-peer consultations. Develop and implement high-quality behavioral health medical policies, programs, and operational standards, monitoring utilization results to drive quality improvement and cost efficiency. Serve as a subject matter expert on behavioral health, offering medical oversight to staff and ensuring members receive safe, effective, and cost-efficient services. Collaborate with provider groups and internal teams to resolve issues, communicate utilization determinations, and stay abreast of industry trends to enhance outcomes. This part-time role involves a maximum of 12 hours per week, with a full salary range of $204,000 - $333,000 and a bonus target of 25% for Oregon, Washington, Idaho, and Utah locations.
Required Qualifications
- Licensed Physician with an MD or DO degree
- Active, unrestricted license to practice medicine in one or more of our 4 states
- Board Certification in general psychiatry or child psychiatry required
- Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review
- At least 3 years clinical experience
- Two years health plan medical utilization management and/or case management experience
- Must be located in one of our four states
- Must be able to lift 50 lbs
Desired Qualifications
- Preference for being board certified in both general psychiatry and child psychiatry
- In-depth knowledge of best practices related to medical care for a wide variety of behavioral health conditions
- Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to effectively manage patient care to improve outcomes
- Passion for population health, healthcare transformation and improving the experience of people with mental health issues
- Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes
- Proven ability to develop and maintain positive working relationships with community and provider partners
- Knowledge of the health insurance industry, state and federal regulations (including Parity Legislation/Regulations), provider reimbursement methods and evolving accountable care and payment models
- Experience conducting medical case reviews for utilization and/or case management
- Detail-oriented with orientation to the application of data and metrics in managing health, quality and program effectiveness
- Leadership experience with demonstrated ability to effectively build relationships, work with others and lead people and project teams
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings
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