Medical Director - Behavioral Health - ABH OH

Position Summary: This is a remote-based (work from home) role. Candidates residing in Ohio are preferred. Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues Participate in the appeals process, including the investigation of adverse events and quality of care concerns Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation and training Provide day-to-day physician oversight including management of high-risk cases throughout treatment/levels of care and medical necessity decisions Assist with the development, implementation, monitoring and evaluation of the utilization management program and action plan, ensuring quality and appropriateness of care Assist with the development, implementation and interpretation of medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments Participate in the development, implementation and evaluation of clinical/medical programs Confer with behavioral health practitioners regarding the care of patients with severe, complex and/or treatment resistant illnesses Identify and address quality of care concerns with providers involved in a member's care Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities in collaboration with clinical and quality improvement staff Participate in the triage and referral for care management Provide weekend coverage every 6-7 weeks. Perform other duties as deemed necessary.

Required Qualifications: Board-certified Psychiatrist currently licensed in the State of Ohio or with the ability to become licensed in the State of OhioActive and current state medical license without encumbrances, and ability to obtain other state licenses. This role requires the ability to get additional state licensures and provide UM coverage across multiple different state health plans.