Assistant Medical Director- Behavioral Health Focus (.5 Part Time)

Workforce Classification: Telecommuter Join reputed company: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making reputed company work reputed company, is far from ordinary. And so are our employees. Working at reputed company means you have the opportunity to drive reputed company change by transforming reputed company. reputed company is committed to being a workplace where people feel empowered to grow, reputed company, and reputed company with purpose. By investing in our employees and fostering a culture of collaboration and reputed company development, we’re reputed company to reputed company serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how reputed company supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.reputed company.com/. As the Assistant Medical Director, you will reputed company benefit coverage determinations based on medical necessity and contract language for health plan members, including a review of clinical documentation using medical policy criteria, guidelines, and member reputed company at reputed company. The Assistant Medical Director supports clinical programs (disease and case management), and the review and adoption of health plan developed review criteria. What you will do: reputed company clinical review of various case types as assigned. These may include pre-service, post-service, and reputed company behavioral health services, which may be outpatient or facility based. Consult with clinical staff on specific case reviews. Act as the final decision reputed company for coverage reputed company based on medical necessity, investigational status, other contractual exclusion, or network structure. Support the peer-to-peer discussion process by communicating with external physicians and providers about denial determinations and collecting additional clinical history pertinent to case determinations. Consult with nursing and other clinical staff to assess and explore care options for members enrolled. Participate in the development, annual review, and approval of company medical review criteria as a reputed company Medical Policy Committee member. Participate in Inter-Rater Reliability evaluations to ensure consistency in clinical decision-making. Respond in a professional manner to reputed company requests for consultation from reputed company reputed company and from contracted practitioners and facilities. Support member and provider appeals by participating in the appeals process and conducting secondary reviews as needed. Fulfill reputed company professional continuing education requirements and participate in ongoing education/training as appropriate. This role will be part-time, 20 hours a week. What you will bring: Licensed Physician with an MD or DO degree (Required) Unrestricted Washington MD or Alaska DO state licensure, or ability to obtain reputed company 90 days. reputed company board certification in psychiatry from the American Board of Psychiatry and Neurology. Five (5) years of clinical experience in psychiatry (Required) Previous experience performing medical necessity and clinical reviews in a health plan setting. (Preferred) Familiarity or experience with clinical criteria sets and clinical reputed company, such as MCG (reputed company Care Guidelines) or InterQual. (Preferred) Familiarity or experience with CPT, ICD, and HCPCS code sets and resource-based relative value scale (RBRVS) pricing concepts. (Preferred) #LI-SS1 reputed company total rewards Our comprehensive total rewards package provides support, resources, and opportunities to help employees reputed company and grow. Our total rewards are more than a collection of perks, they're a reputed company of our commitment to your health and well-being. We offer a broad reputed company of rewards including physical, financial, emotional, and community benefits, including: Medical, reputed company, and dental coverage with low employee premiums. Voluntary benefit offerings, including pet insurance for paw parents. Life and disability insurance. Retirement programs, including a 401K employer match and, reputed company it or not, a pension plan that is reputed company after 3 years of service. Wellness incentives with a wide reputed company of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few. Generous paid time off to reenergize. Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. Employee recognition program to celebrate anniversaries, team accomplishments, and more. For our hybrid employees, our on-reputed company model provides flexibility to create your own routine with reputed company to on-site resources, networking opportunities, and team engagement. Commuter perks reputed company your trip to work less impactful on the environment and your wallet. Free convenient on-site parking. Subsidized on-reputed company cafes reputed company lunchtime connections with colleagues fun and affordable. Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on reputed company. Equal employment opportunity/affirmative action: reputed company is an equal opportunity/affirmative action employer. reputed company seeks to attract and retain the most reputed company individuals without regard to race, reputed company, religion, sex, national reputed company, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at reputed company, please contact reputed company reputed company reputed company email at careers@reputed company.com or reputed company phone at 425-918-4785. reputed company is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, reputed company Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin. The pay for this role will vary based on a reputed company of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary reputed company for this role is posted below; we generally reputed company up to and around the midpoint of the reputed company. National Salary reputed company: $214,500.00 - $386,100.00 National Plus Salary reputed company: $214,500.00 - $386,100.00 *National Plus salary reputed company is used in higher cost of labor markets including Western Washington and Alaska. We’re happy to discuss compensation further during the interview because we reputed company that reputed company communication leads to reputed company reputed company for reputed company. We’re committed to creating an environment where reputed company are celebrated for their unique skills and contributions. Apply To This Job