Job Title: Behavioral Health Medical Director
Location: Remote – Ohio (OH License with OH Residency + Domicile Commitment)
Schedule: Part-time (approximately 24 hours per week, 3 days)
(Potential for full-time employment in the future)

Compensation: USD $160,000 – $180,000 per year

Requirements:

• Must reside in Ohio and hold a current, unrestricted OH state license as an MD or DO

• Board certification in General Psychiatry (American Board)

• 5+ years of experience in behavioral health managed care or behavioral health clinical settings, including at least 2 years in a clinical setting

• Certification in Addiction Medicine or the subspecialty of Addiction Psychiatry preferred

Position Purpose

Assist the Chief Medical Director in directing and coordinating medical management, quality improvement, and credentialing functions for the business unit.

Key Responsibilities:

• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.

• Conduct medical reviews related to utilization, quality assurance, and complex or experimental services to ensure timely and appropriate decisions.

• Support performance improvement initiatives for capitated providers.

• Aid in planning and establishing goals and policies to enhance quality and cost-effectiveness of care and services.

• Offer medical expertise in implementing quality improvement and utilization management programs in compliance with regulatory and accreditation standards.

• Assist with physician committee functions, including structure, processes, and membership.

• Conduct rounds for high-risk patients, coordinating with care management teams to optimize outcomes.

• Collaborate with clinical teams, network providers, appeals teams, and pharmacy consultants to review complex cases and medical necessity appeals.

• Participate in provider network development and market expansion efforts.

• Contribute to physician education initiatives addressing clinical issues and policies.

• Identify and evaluate utilization review studies and trends in provider practices and service utilization.

• Lead clinical quality improvement studies to reduce unwarranted variations in practice and improve care quality and efficiency.

• Interface with physicians and providers to implement recommendations enhancing utilization and healthcare quality.

• Review claims involving complex or new services to determine medical necessity and appropriate reimbursement.

• Develop provider community alliances through medical management program initiatives.

• Represent the business unit at state and national levels on medical philosophy, policies, and related matters.

• Attend state and ad hoc committees as required.

• May occasionally work weekends or holidays in support of business operations.

Education & Experience

• Medical Doctor (MD) or Doctor of Osteopathy (DO)

• Actively practices medicine

• Experience or coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management preferred

• Experience managing care for culturally diverse populations preferred

• Utilization management experience and familiarity with quality accreditation standards preferred

• Minimum of 5 years post-residency or fellowship experience

Required Skills

• Current OH state license as an MD or DO (unrestricted)

• American Board Certification in General Psychiatry

Preferred Skills

• Certification in Addiction Medicine or the subspecialty of Addiction Psychiatry

License/Certifications:

• Current, unrestricted Ohio MD or DO license

• Board Certification in General Psychiatry or Child Psychiatry

• Certification in Addiction Medicine or Addiction Psychiatry (preferred)