Medical Director (BH, UM) Remote HI
Core
Provides clinical leadership and physician oversight for an interdisciplinary Utilization Management (UM) team, managing cost and quality of care across Medicaid, Medicare, and Commercial lines of business.
Role type
Senior Medical Director (Utilization Management)
Builds
Utilization Management programs, medical policies, and coordinated care plans for at-risk patients.
Domain
US Healthcare / Utilization Management / Behavioral Health
Required skills
Physician leadership, Utilization Management, medical necessity determination, case management, quality improvement, policy development, appeals process management, cost-benefit analysis, credentialing.
Preferred skills
Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care, Physical Medicine.
Technologies
NCQA, URAC, ACGME, ABMS.
Responsibilities
Provide clinical leadership to the interdisciplinary Medical Management team; oversee medical necessity decisions and case management for at-risk patients; develop and implement Utilization Management programs and action plans; interpret medical policy and technology assessments; manage the appeals process and investigate adverse incidents; ensure compliance with accreditation standards and state/federal policies.
Seniority
Senior, hands-on IC