AltaStaff is a staffing agency currently looking for a Utilization Management (UM) Behavioral Health Physician to work with our Managed Care Client!
**This role is a 1099 Independent Contractor role**
Location: Remote (Must have a MD or DO license in Florida and/or Ohio)
Hourly pay rate: Range will depend on the specialty, licenses, clinical and MCO experience: $50 - $57/case for all UM, $150-$170/hour for mandatory trainings and meetings
Estimated hours per week: Preferred M - F, including Saturdays. 20 hours minimum availability.
*Qualified candidates must have a valid MD or DO licensure with board certification in Psychiatry*
Summary: The Behavioral Health Physician will serve as an independent contractor providing physician-level utilization management (UM) services for behavioral health services. This role is non-clinical and limited exclusively to medical necessity determinations, peer-to-peer reviews, and appeals in accordance with applicable regulations, accreditation standards, and plan policies.
RESPONSIBILITIES:
Initial Medical Necessity Reviews for behavioral health services requiring physician-level determination
Concurrent Reviews for continued authorization of services
Peer-to-Peer (P2P) Reviews with treating providers
Appeals Reviews, including first- and second-level determinations, as applicable
Issuance of adverse determinations when clinically indicated, ensuring compliance with federal and state regulations, parity requirements, and plan policies
Documentation of determinations in UM systems with clear clinical rationale and supporting criteria
Participation in quality improvement processes related to UM decisions, as requested
QUALIFICATIONS:
MD or DO with board certification in Psychiatry (required)
Active, unrestricted medical license in applicable state(s) of review
Experience in behavioral health utilization management, preferably in managed care or health plan settings
Knowledge of Medical necessity criteria (e.g., MCG, InterQual, or equivalent)
Knowledge of MHPAEA requirements, NCQA and CMS standards
AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.
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