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1d

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Medical Director-Board Certified in Psychiatry-MD or DO

The Maxis Group
Remote

Quick Apply

Job Details

Part-time
$50 - $170 an hour

Qualifications

Board Certification in Psychiatry
Doctor of Medicine
Utilization review
Psychiatry
Clinical psychiatry
CMS
CMS regulatory compliance
Utilization management
Clinical documentation
Resource utilization in healthcare
Health information regulatory compliance
Doctor of Osteopathy
Medical License

Full Job Description

Medical Director-Board Certified MD or DO in Psychiatry

Large Managed Care Compnay

DIRECT PLACEMENT OPPORTUNITY - THE PHYSICIAN WILL BE DIRECTLY CONTRACTED WITH AS A 1099.

Preferred M - F including Saturdays. 20 hours minimum availability.

Flexible hours

Licensed in either Florida or Ohio or both

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

Behavioral Health Physician (MD/DO) – Utilization Management (1099 Contractor)
Role 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.
Scope of Services
The Contractor will perform UM activities including, but not limited to:

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
Exclusions / Non-ScopeThis role does not include:
Direct patient care or treatment
Prescribing services
Care coordination or case management
Administrative leadership or supervisory responsibilities

Clinical Expertise & Requirementso Medical necessity criteria (e.g., MCG, InterQual, or equivalent)o Federal and state behavioral health regulationso MHPAEA requirementso NCQA and CMS standardsWork ExpectationsReporting & Oversight

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
Demonstrated knowledge of:
Strong peer-to-peer communication skills
Independent contractor (1099) status
Remote work environment
Flexible scheduling based on case volume and turnaround time requirements
Ability to meet required regulatory and contractual decision timelines
Maintain confidentiality and comply with HIPAA and data security standards
Operates independently while adhering to health plan UM policies, delegated authority parameters, and medical policy
Subject to audit, quality oversight, and performance monitoring consistent with UM regulatory requirements

Must be a Licensed M.D. or D.O.

Must be Board Certified in Psychiatry

#ALLJ

Pay: $50.00 - $170.00 per hour

Work Location: Remote

Quick Apply

Refine Your Search

contractor regulatory jobs in remote

Medical Director-Board Certified in Psychiatry-MD or DO

Client Solutions Manager (Sales and Business Development)

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Specialist, Onboarding Compliance

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Controller

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