Job Description:
We are seeking experienced Behavioral Health Medical Director for PART-TIME- (3 days a week) fully remote opportunities supporting managed care and utilization management operations. This roles focus heavily on adult psychiatry and substance abuse cases, providing clinical oversight, medical necessity determinations, peer-to-peer consultations, and collaboration with multidisciplinary medical management teams. The position support utilization management, quality management, case management, disease management, accreditation activities, and integrated behavioral healthcare initiatives within a managed care environment.
Responsibilities:
- Conduct medical necessity and coverage reviews for behavioral health and substance abuse cases utilizing InterQual and ASAM guidelines
- Review prior authorizations, concurrent reviews, appeals, grievances, and case management activities
- Participate in peer-to-peer discussions with providers regarding treatment determinations and level of care decisions
- Collaborate with CMOs, Medical Directors, utilization management leadership, and clinical teams on behavioral health initiatives
- Support accreditation and regulatory compliance efforts including NCQA and URAC standards
- Provide consultation and clinical guidance to utilization management, quality management, disease management, and case management teams
- Document clinical findings, determinations, and outcomes in accordance with regulatory and accreditation standards
- Participate in committees, focused studies, physician-to-physician communications, and special projects related to behavioral health management
- Educate providers regarding medical policy, benefit interpretation, and behavioral health best practices
- Support integrated behavioral healthcare management strategies across the organization
Requirements:
- MD or DO degree required
- Board Certification in Psychiatry required
- Minimum 5 years of post-residency clinical experience including inpatient and outpatient behavioral health care
- Minimum 3-5 years of managed care, utilization management, quality management, or medical management experience required
- Experience with utilization management, case management, disease management, and behavioral health reviews required
- Strong understanding of InterQual, ASAM, medical necessity criteria, and accreditation standards preferred
- Experience conducting peer-to-peer reviews and appeals/grievance determinations preferred
- Candidates who are open to getting Pennsylvania licensed, can currently hold their Texas OR Ohio OR New Jersey OR Minnesota OR Illinois OR Florida OR Delaware OR Colorado OR Pennsylvania OR Arizona OR Alabama OR Currently have their unrestricted Pennsylvania (PA) medical license.
Key Skills:
Behavioral Health Psychiatry Utilization Management Managed Care InterQual ASAM Peer-to-Peer Reviews Appeals & Grievances Quality Management Case Management Disease Management Medical Necessity Reviews Accreditation Support Substance Abuse Treatment Behavioral Health Operations
Pay Range: 150
Compensation varies based on experience, schedule availability, and employment structure.
Benefits:
Our comprehensive benefits package includes:
o Medical insurance
o Dental insurance
o Vision insurance
o 401(k) retirement savings plan
Contact:
Karrie Ruch
+1 (312) 884-0418
[email protected]
Refer a Colleague:
If you know someone who may be interested in this opportunity, please email the Jacobson contact listed above or submit a referral through our referral program. If your referral is hired for a contract assignment and meets all eligibility requirements, you may qualify for a referral bonus.
Equal Opportunity Employer:
The Jacobson Group is an Equal Opportunity Employer. We welcome applicants of all backgrounds and experiences. Applicants requiring accommodation in the application process may contact [email protected] or call +1 (800) 466-1578.
Pay: From $150.00 per hour
Application Question(s):
- What health plan lines have you supported (Commercial / Medicare / Medicaid)? (Multi-select)
- Any prior NCQA / URAC accreditation support experience?
Experience:
- Utilization management: 3 years (Required)
License/Certification:
- Board Certified in Psychiatry (Required)
Work Location: Remote
