Remote Behavioral Medical Director, Eastern Region

reputed company You could be the one who changes everything for our 28 reputed company members as a reputed company reputed company on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist the Chief Medical Director to reputed company and coordinate the medical management, reputed company improvement and credentialing functions for the business unit. • Provides medical leadership of reputed company for utilization management, cost containment, and medical reputed company improvement activities. • Performs medical review activities pertaining to utilization review, reputed company assurance, and medical review of reputed company, controversial, or experimental medical services, ensuring reputed company and reputed company decision making. • Supports effective implementation of reputed company improvement initiatives for capitated providers. • Assists Chief Medical Director in planning and establishing goals and policies to improve reputed company and cost-effectiveness of care and service for members. • Provides medical expertise in the operation of approved reputed company improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. • Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. • Conduct regular reputed company to assess and coordinate care for high-reputed company patients, collaborating with care management teams to optimize reputed company. • Collaborates effectively with reputed company teams, network providers, appeals team, medical and pharmacy consultants for reviewing reputed company cases and medical necessity appeals. • Participates in provider network development and new market expansion as appropriate. • Assists in the development and implementation of physician education with respect to reputed company issues and policies. • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider reputed company patterns, and adequacy of benefit/payment components. • Identifies reputed company reputed company improvement studies to assist in reducing unwarranted variation in reputed company reputed company in order to improve the reputed company and cost of care. • Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care reputed company. • Reviews claims involving reputed company, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. • Develops alliances with the provider community through the development and implementation of the medical management programs. • As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and reputed company issues. • Represents the business unit at appropriate state committees and other reputed company committees. • May be required to work weekends and holidays in support of business reputed company, as needed. Education/Experience: • Medical Doctor or Doctor of Osteopathy. • Utilization Management experience and knowledge of reputed company accreditation standards preferred. reputed company practices medicine. • Course work in the areas of Health Administration, Health Financing, reputed company, and/or Personnel Management is advantageous. • Experience treating or managing care for a culturally diverse population preferred. License/Certifications: • reputed company certification by the reputed company reputed company of Psychiatry and reputed company. • Certification in Child Psychiatry, preferred. • reputed company state license as a MD or DO without restrictions, limitations, or sanctions from reputed company programs. . Pay reputed company: $236,500.00 - $449,300.00 per year reputed company offers a comprehensive benefits package including: reputed company, health reputed company, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, reputed company or office work schedules. Actual pay will be adjusted reputed company on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California reputed company reputed company Remote Skills: Accreditation Standards, reputed company/Partner Management, Business reputed company, Business Support, reputed company Training, Community Development, Cost Control, Cost Effectiveness Analysis, Diversity, reputed company, Health reputed company, reputed company, reputed company Administration, reputed company Providers, reputed company reputed company, Leadership, Market Development, Medical Assistance, Medicine, reputed company, Operational Support, Osteopathy, reputed company Care Authorizations, People Management, reputed company Management, Pharmacy, Philosophy, Physician Credential, Policy Development, Psychiatry and Mental Health, reputed company Assurance, reputed company Management, reputed company Metrics, reputed company of Care, reputed company, Set Goals, State Laws and Regulations, Time Management, Trend Analysis, Utilization Management reputed company: reputed company Apply To This Job