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Medical Director - Remote - Psychiatry
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Job Location: Richmond, VA
Leading health plan seeks a Medical Director - Psychiatry, to oversee the utilization management plan for various Virginia affiliated health plans. The Medical Director - Psychiatry should be and M.D. or D.O. with a speciality in psychiatry, and either an active Virginia medical license or the ability to obtain one. This is a remote role, but candidates need to live in Virginia or adjacent states and be available to travel about once a month to Richmond for meetings. Requirements for the Medical Director Psychiatry:
  • M.D. or D.O. licensure in Virginia, ABMS board certification in psychiatry
  • Completion of psychiatric residency in the U.S. or Canada, approved by the ACGME
  • 5+ years post residency clinical psychiatric care experience
  • Experience in managed care, health plans
Responsibilities for the Medical Director - Psychiatry:
  • Develop and implement a Utilization Management program and action plan.
  • Manages UM practices including over and under utilization, evaluating UM practices and criteria.
  • Provide direct support to UM and clinical care teams.
  • With corporate clinical team implements clinical practice standards and policies and participates in management of activities.
  • Develop, implement and interpret medical policy, technology assessments, and medical necessity guidelines.
  • Develop working relationships with practitioners, provider facilities, treatment programs, conferring directly with psychiatrists and other practitioners regarding the care of patients with severe, complex, and/or treatment resistant illnesses.
  • Ensures that contract requirements, accreditation standards (e.g. NCQA), state policies and federal policies are implemented specific to each client.
  • Work with teams on continuous quality improvement to ensure ongoing compliance in utilization and case management.
  • Participate in and maintain the integrity of the appeals process, both internally and externally.
  • Investigate adverse incidents and quality of care concerns.
  • Participate in preparation for NCQA and URAC certifications.
  • Develop and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead senior medical director, and quality improvement staff.

How To Apply:
You will be directed to another website for application instructions.
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