Medical Director (Psychiatry), Addictions - Remote | Wfh

We are looking for a passionate and experienced adult psychiatrist with a background in addiction treatment to join our team as a Medical Director. This full-time position (30-40 hours) will support the clinical vision for our health plan(s) and implement programs to support this vision. The position may serve multiple health plans managed by our Clinical Center of Excellence.
As the Medical Director, you will provide clinical leadership to our interdisciplinary Medical Management team. This includes clinical/medical oversight of clinical team members and consultation and training with care managers to address the cost and quality of care. You will be responsible for providing day-to-day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and making medical necessity decisions. You will also follow high-risk cases throughout the treatment continuum, from inpatient care to outpatient and other levels of care, to ensure that patients with severe, complex, and/or treatment-resistant illnesses receive medically necessary coordinated care throughout their treatment.
In this role, you will develop and implement a Utilization Management program and action plan, which includes strategies to ensure a high quality of patient care, and that patients receive the most appropriate care at the most cost-effective setting. You will evaluate the effectiveness of UM practices and criteria, actively monitor for over- and under-utilization, and assume a leadership position relative to knowledge, implementation, training, and supervision of the use of the medical necessity criteria.
You will also develop effective working relationships with practitioners, provider facilities, treatment programs, and may establish relationships and/or consult with client organizations. As a Medical Director, you will confer directly with psychiatrists and other practitioners regarding the care of patients with severe, complex, and/or treatment-resistant illnesses through peer review and educational interventions. You will identify and immediately follow up on any quality of care concerns with practitioners and provider facilities and treatment programs involved in the member’s care. You will ensure that contract requirements, accreditation standards (e.g., NCQA), state policies, and federal policies are implemented specifically for each of our clients.
Additionally, you will participate in and maintain the integrity of the appeals process, both internally and externally, and be responsible for the investigation of adverse incidents and quality of care concerns. You will participate in preparation for NCQA and URAC certifications and provide leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead senior medical director and quality improvement staff. You may also participate in various committees or project teams as directed by the senior medical director or vice-president.
To be considered for this role, you must hold a Doctor of Medicine (MD) degree OR Doctor of Osteopathic Medicine (DO) degree OR Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with successful completion of a United States-based internship and residency (and successful completion of a United States-based fellowship for subspecialists). You must have full training in a residency program in the United States or Canada that is approved by the Accreditation Council for Graduate Medical Education (ACGME), a minimum of three years involving substantial direct patient care during this period at multiple levels of care, and clinical experience pertinent to the patient population(s) being managed. You must also hold an unrestricted current and valid license or certification to practice medicine in a state or territory of the United States.
We offer a competitive salary range for this position with a minimum of $178,820 and a maximum of $321,880, along with a comprehensive benefits package. We are proud to be an Equal Opportunity Employer and a Tobacco-free workplace. We believe in providing our employees with a broad range of health, life, voluntary, and other benefits and perks that enhance their physical, mental, emotional, and financial wellbeing.