Medical Director of Behavioral Health (MD) - Managed Care
Boston, MA
*** This is a Full-Time, Benefits Available, INTERIM / CONTRACT position expected to last several months or longer! ***
Medical Director Job Summary:
- The Medical Director of Behavioral Health programs will support the staff of the Office of Clinical Affairs in medical management including utilization review and concurrent review
- May also be involved with other internal processes such as quality, appeals and grievances, and pharmacy management
- Provides clinical case review, consultation and oversight for all utilization management activities
- Conducts review of prior authorizations, concurrent reviews and retrospective reviews that do not meet standard criteria and determines coverage
- Conducts clinical review of appeals and grievances
- Develops and supports clinical initiatives to support department quality improvement and utilization management goals
Medical Director Background:
- Current unrestricted licensure as an M.D. in Massachusetts is required. Board certification in psychiatry is required
- Prior experience performing Utilization Reviews
- Experience in a health insurance or other managed care setting strongly preferred
- Knowledge of InterQual protocols, HEDIS, and other quality measures
- Knowledge of federal Medicaid and MassHealth regulations, guidelines, and standards Experience with prior-authorization, utilization review, and appeals
- 8-10+ years of related experience is required including a minimum of 5 years direct clinical experience and a minimum of 3 years experience in medical management in a managed care setting
- Comprehensive knowledge of InterQual protocols, HEDIS, and other quality measures
- Knowledge of federal and state Medicaid regulations, guidelines, and standards
- Proven leadership skills and relationship building. Ability to work independently with intermittent supervision
- Ability to travel to locations within New Hampshire and Massachusetts
#CLINICAL
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