Behavioral Health Physician Reviewer (Medical Director)

Description

Behavioral Health Medical Director – Full Time, Utilization Review Position Description

The Medical Director leverages their medical experience and judgment to determine whether requested services, levels of care, and/or sites of service should be authorized. This role operates within a framework of criteria from the patient’s healthcare plan, regulatory compliance, and utilizing diverse resources such as national clinical guidelines, CMS policies, clinical reference materials, internal teaching conferences, and other references.

KEY RESPONSIBILITIES



Medical Decision Making: Leverage in-depth inpatient clinical expertise, including familiarity with MCG/InterQual guidelines and health plan policies, along with acute care, co-morbidities, and disease management experience, to review medical records and deliver evidence-based determinations on service requests.

Communication: Conduct peer-to-peer phone calls with external providers to obtain additional clinical information and discuss case determinations.

Collaboration: Follow established procedures to support internal workflows and foster effective working relationships across teams and stakeholders.

Compliance and Support: Ensure all decisions and processes adhere to national guidelines, CMS regulations, URAC standards, clinical best practices, and contractual requirements.

Ideal Candidate Profile

• MD or DO, board certified in Psychiatry (additional board certification in Child & Adolescent or Addiction Medicine is highly preferred)
• Willing and able to work the structured schedule: This is NOT a flexible position. You will be scheduled 40 hours per week (5, 8 hours shifts per week) which may include some weekend shifts. Work hours are between 7:00am – 5:00pm Mountain Time Zone. Your full attention must be dedicated to the position during scheduled hours. No exceptions to the schedule will be permitted.
• Medical skill and experience: Highly skilled in managing in-patient co-morbidities, with the ability to apply clinical judgement to determine appropriate patient outcome.
• Computer skill: Be highly adept with computers, possess above average computer literacy.
• Integrity and Professionalism: Demonstrates a high degree of integrity and professionalism.
• Resourcefulness: Ability to utilize available resources effectively to make informed decisions.
• Team Collaboration: Supports and collaborates with team members, other departments, colleagues, and leadership.
• Independence and Structure: After completing structured and mentored training, performs daily tasks with minimal supervision but with ready support from team members. Enjoys working in a structured environment with consistent thinking and authorship.

Requirements

To qualify for this position, you must meet the following requirements:

• MD or DO degree, with current board certification in Psychiatry-required.
• Additional Board Certification in Child & Adolescent or Addiction Medicine is highly preferred
• 5 years of recent direct patient care experience
• Be highly adept with computers, with strong computer literacy.
• Be willing to obtain additional state licenses (MRIoA will manage and cover the cost of licenses and CME requirements to maintain them).
• Clean background, without any prior licensure issues or pending malpractice (background or malpractice issues can delay the process of obtaining additional licenses).
• You must be fully committed to the job during your scheduled hours. This position does not allow for any caregiving or other responsibilities during your scheduled work hours. 
• You must reside and work within the United States.

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Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.

NOTE: For California Residence - California Consumer Privacy Act (CCPA) Information:

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.

Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please contact Medical Review Institute of America (MRIoA) at Contact.