Behavioral Health Medical Director
Core
Provide medical leadership for utilization management, quality improvement, and credentialing functions across diverse markets and lines of business.
Role type
Senior Behavioral Health Medical Director
Builds
Utilization management programs, quality improvement initiatives, and provider network strategies
Domain
Healthcare / Behavioral Health / Utilization Management
Required skills
Board certification in Psychiatry, current unrestricted MD or DO license, medical review expertise, utilization management experience, quality accreditation knowledge, care coordination, provider network development, clinical policy implementation
Preferred skills
Addiction specialty experience, Health Administration coursework, experience with culturally diverse populations, knowledge of state regulatory requirements
Technologies
None stated
Responsibilities
Lead utilization management and cost containment activities; perform medical reviews for complex or experimental services; support performance improvement initiatives for capitated providers; assist in planning quality and cost-effectiveness goals; conduct rounds for high-risk patients; collaborate on medical necessity appeals; participate in provider network development; develop physician education programs; evaluate utilization trends and adverse patterns; represent the business unit at state committees and public forums
Seniority
Senior, hands-on IC with strategic oversight