Medical Director-Psychiatry
Core
Provide clinical leadership and expertise in utilization management, ensuring healthcare services are medically necessary, evidence-based, and aligned with regulatory requirements.
Role type
Senior Medical Director (Psychiatry)
Builds
Utilization management processes and member outcomes
Domain
Healthcare / Insurance / Utilization Management
Required skills
Board certification in Psychiatry, Medical necessity review, Prior authorization management, Peer-to-peer discussions, Medical policy development, Quality improvement, Clinical governance, Evidence-based medicine, Regulatory compliance, Electronic health record (EHR) systems
Preferred skills
Experience in managed care organizations, Analytical and critical-thinking skills, Written and verbal communication skills, Self-motivation, Adaptability
Technologies
Electronic health record (EHR) systems, Utilization management software
Responsibilities
Conduct comprehensive prospective, concurrent, and retrospective reviews across a broad range of healthcare services, Perform thorough prior authorization reviews to ensure decisions align with clinical criteria, Lead discussions with requesting practitioners, communicate clinical rationales clearly, Issue medical necessity denials when warranted, Contribute to the creation, review, and revision of medical policies, Participate in quality improvement initiatives, audits, and clinical committee meetings, Maintain accurate and comprehensive records of review activities, clinical decisions, and peer-to-peer interactions, Stay informed about medical literature, healthcare developments, regulatory changes, and industry best practices in utilization management, Promote a member-focused approach while balancing clinical effectiveness, appropriate resource utilization, and cost considerations, Adapt to evolving organizational needs, take a proactive approach to problem-solving, and contribute hands-on to the development of clinical operations
Seniority
Senior, hands-on IC