Medical Director - Psychiatry - REMOTE

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San Diego, CA
Job Type
Direct Hire
Jul 22, 2019
Job ID
Leading health plan seeks a Medical Director - Psychiatry, to oversee the utilization management plan for various California affiliated health plans.  The Medical Director - Psychiatry should be and M.D. or D.O. with a speciality in psychiatry, and an active California medical license.  

Requirements for the Medical Director Psychiatry:

  • M.D. or D.O. licensure in California, 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. 

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