Behavioral Health Medical Director

About the role

Clinical judgment meets coverage rules: you weigh requests for care against guidelines and regulatory requirements, and you may shape procedures, productivity targets and new delivery models.

At a glance

What you will do

• Set behavioral health care strategy and oversee operations
• Keep operations efficient while meeting quality of care and financial goals
• Decide whether requested services, level of care or site of service should be authorized
• Learn Medicare, Medicare Advantage and Medicaid requirements and apply them daily

What they look for

• MD or DO degree
• 5 or more years of direct clinical patient care after residency or fellowship, ideally with some inpatient or Medicare and Medicaid populati
• Current board certification in an approved ABMS or ABPN specialty
• No current federal or state sanctions, and able to pass credentialing
• Strong written and verbal communication

Nice to have

• Knowledge of managed care, including Medicare Advantage, managed Medicaid or commercial products
• Familiarity with national guidelines such as MCG or InterQual
• Clinical background in psychiatry, internal medicine, family practice, geriatrics, hospital medicine or emergency medicine