Behavioral Health Medical Director

    • Job Tracking ID: 512935-735520
    • Job Location: Montpelier, VT
    • Job Level: Management
    • Level of Education: Masters Degree
    • Job Type: Part-Time
    • Date Updated: June 25, 2020
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
    • Salary Type:: Hourly
    • Rate:: $100-$115 per hour DOE / 4-10 hours per week with possible opportunity to increase
Invite a friend
facebook LinkedIn Twitter Email


Job Description:

Job Summary

The Behavioral Health Medical Director is responsible for the administration of behavioral health services for employer group health plans including the overall behavioral health policies of the business unit to ensure the appropriate and most cost-effective behavioral health care is received. Assists the Senior Medical Director as needed in the day-to-day clinical oversight of the Behavioral Health UM Program and is actively involved in implementing and evaluating the Behavioral Health aspects of the UM program. Provides mentoring for employed or contract physicians and participates on clinical project teams.

The Behavioral Health Medical Director conducts member case reviews such as prior authorizations and appeals. Provides peer-to-peer consultations with providers and clinical expertise to staff on utilization and case management reviews. Responsible for collaborating with providers and Medical Directors to determine appropriateness of level of care based on medical necessity criteria. Outpatient levels of care include: Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Partial Hospitalization/Day Treatment, Mental Health Support Services Individual Therapy, Group Therapy, Family Therapy, and Marriage/Couples Therapy.

Key Result Areas

Primary duties may include, but are not limited to:

  • Conducts pre-certification, concurrent review, and appeals of Behavioral Health services.
  • Interprets existing policies and develops new policies based on changes in the behavioral health arena.
  • Identifies and assists in developing new opportunities for innovation in utilization management, case management, health management or other areas to increase effectiveness, quality and outcomes.
  • Stays abreast of industry, behavioral health and technology trends.
  • Serves as a resource and consultant to other areas of the company and may chair or serve on company committees/projects; may be required to represent the company to external entities and/or serve on external committees; may provide formal presentations to clients/external entities at client meetings and/or conferences
  • Mentors Behavioral Health staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives.
  • Partners with internal UR staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines within scope
  • Conducts peer clinical and/ or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations.
  • Promotes provider understanding of utilization management and quality improvement policies, procedures and standards.
  • Supports the medical management staff ensuring timely and consistent responses to members and providers
  • Provides behavioral health expertise, oversight and leadership for staff to ensure members receive safe, effective and cost-efficient services.
    • Provides behavioral health input on case management reviews/services working closely with the Case Management clinical staff.
    • Participates on various teams to provide input on behavioral health policy reviews and development and may participate on committees that develop programs impacting behavioral health interventions, utilization management, case management and health management.
    • Assists with oversight of operational and administrative processes to ensure Behavioral Health standard operating policies remain in compliance with industry standards, licensing, and accreditation/certification boards.
    • Ensures accuracy and confidentiality is maintained with all documentation.
    • Performs other duties as assigned or needed.

Experience and Skills:

Minimum Qualifications

  • Physician (M.D. or D.O) or have a clinical PhD or PsyD in clinical/counseling psychology
  • Possess an active unrestricted medical license to practice medicine or as a Clinical/Counseling Psychologist in a state or territory of the United States
  • Board Certification approved by the American Board of Medical Specialties required where applicable to duties being performed.
  • Managed care experience, including experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background. 2-5 years experience in a Behavioral Health/Clinical setting preferred.
  • Utilization Review background a plus.
  • Knowledge/understanding of determining medical necessity, utilization review principles, and Continuous Quality Improvement theory and practice.
  • Experience with performance measurements (HEDIS, NQF and other systems), accreditation standards (NCQA, URAC), member satisfaction and patient safety preferred.
  • Proficiency with the use of a variety of software applications (e.g., Microsoft Word, Excel, and PowerPoint).
  • Ability to travel out of the office to meet with clients/external entities.
  • Advanced presentations skills with the ability to plan, facilitate and present at meetings, conferences, etc.
  • Requires strong oral, written and interpersonal communication skills, problem solving skills, facilitation skills.
  • Ability to provide excellent customer service/professionalism, work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines.
  • Ability to mentor and develop staff and communicate with other physicians and team members effectively and respectfully.
  • Ability to research, interpret and apply medical scientific evidence to case reviews and interpret aggregated utilization data to identify areas of outlier and/or aberrant practices.
  • Possess a high degree of integrity and discretion, as well as the ability to adhere to both company policies and best practices.
  • Ensure compliance with security practices and procedures, including HIPAA and HITRUST standards.
  • Ability to efficiently and effectively perform the Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.
  • Protect and enhance the Core Purpose and the Core Values of AmeriBen.

AmeriBen is an Equal Opportunity/Affirmative Action Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.

If you are unable to use our online application process due to a disability, please contact the Human Resources Department at humanresources@ameriben.com