Medical Director

Who We Are

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our purpose is to advocate for and improve the overall well-being of those we serve, through balanced treatment of the mind and body.

When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.

Why join our team at Lucet?

We are a team of collaborative and hard-working professionals working to improve behavioral health outcomes working in a fast-paced and changing environment. At Lucet, no two days are the same. If you find joy in meaningful work and delivering excellent results, we encourage you to apply!

Benefits

We are looking for top-tier skills and experience in our remote-work environment and that’s because we offer top-tier compensation and benefits, which include:

• Annual compensation between $270,000 - $310,000, PLUS an annual performance-based, discretionary incentive. Compensation is dependent on non-discriminatory factors including but not limited to an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.
• Health Insurance – $0 premium for employee-only coverage in our core program for those participating in our Wellbeing Incentive Program.
• 401(k) with competitive employer match
• Company paid life and disability insurance, wellbeing incentives, and parental leave
• Professional development opportunities and tuition reimbursement
• Paid time off including paid time off for volunteering
• Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.
  
  

What You Will Do - Essential Functions

The Medical Director provides medical oversight and direction of clinical programs including Utilization Management, Disease Management, Pharmacy Management, and Case Management programs. The role emphasizes utilization functions, including initial and concurrent medical necessity reviews, peer reviews as indicated and expedited appeals. The Medical Director manages medical outcomes and expense initiatives, including oversight and supervision of all medical/peer review activities for their assigned customers.

• Clinical Leadership and Medical Management:
• Serve as the Medical Director for assigned health plans, ensuring regulatory and accreditation compliance.
• Oversee medical management, including utilization reviews and clinical decision-making.
• Educate clinical teams to enhance decision-making and improve patient outcomes.
• Provide clinical consultation to in-network and out-of-network providers to enhance decision-making and cost-effective care.
• Conduct market research to understand the needs and preferences of target populations, using insights to drive the development of innovative solutions.
• Compliance and Quality Improvement
• Identify opportunities to improve medical outcomes, manage pharmacy expenses, and implement quality initiatives.
• Evaluate new technologies, medications, and treatments for alignment with best practices and cost-effectiveness.
• Ensure adherence to accreditation and regulatory requirements.
• Conduct standard and expedited appeal reviews, including peer-to-peer evaluations.
• Support Independent Review Organizations (IROs) in ensuring high-quality case outcomes.
• Cross-functional and Provider Collaboration
• Work with network operations to align medical management with provider relationships and access standards to improve outcomes, quality and access to care.
• Maintain positive relationships with health plan stakeholders, including medical, legal, network, quality, and clinical staff.
  

Who You Are

• Required Qualifications
• Medical Degree with an active, unrestricted license or certification to practice as an independent health professional in their state of residency and ability to be licensed in the state in which they will practice
• Willingness to obtain additional licenses in different states, upon request
• Board certified in psychiatry and/or child or adolescent psychiatry
• 3+ years of experience in managed care environment and/or utilization management
• 5+ years of experience as a practicing psychiatrist
• 1+ years of clinical leadership experience.
• Accessible and visibly involved in medical community
• Proven ability to lead clinical initiatives and drive strategic planning
• Working knowledge of managed care for higher levels of care, short-term outpatient methodologies, disease management, case management, and integrated medical management.
• In-depth understanding of regulatory standards and compliance requirements in behavioral healthcare.
• Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen.
• Someone who embodies our values by:
• Serving everyone with compassion and leading with empathy.
• Stepping up and creating value by taking charge and acting when there is an opportunity.
• Adapting in a changing world by recognizing our responsibility to be agile and respond quickly.
• Nurturing growth and belonging by respecting and celebrating everyone for who they are.
• Competencies
• Strong analytical, problem solving and project management skills with the ability to make data-driven decisions.
• Excellent presentation and written communication skills, with the ability to collaborate effectively with cross-functional teams.
• Excellent interpersonal, organizational and time management skills
• Ability to lead and motivate team members
• Highly professional, poised and resilient and ability for creative problem resolution.
• Responsible with a high level of integrity and ethical standards
• Intuitive nature to identify compliance irregularities
• Working Conditions:
• Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary.
• A quiet workspace with minimal background noise for calls.
• High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting).
  

We encourage applicants with a range of experiences who can demonstrate how their qualifications and skills align with the requirements of this role.

This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest