utilization management – MD – Psychiatrist

The Judge Group
Published
January 14, 2022
Location
Atlanta, GA
Category
Job Type

Description

Location: REMOTE
Description: Currently seeking a utilization management - MD - Psychiatrist
Job Description Summary: Works closely with the Health Plan Medical Director in cases requiring behavioral health expertise for prior, concurrent, and retrospective authorizations for members. You will use professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases to integrated care management as needed. You will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Health Plan Medical Director when indicated. You are responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible. You will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit’s business and uses clinical judgment in their application. You must have experience with government funded programs and working with the vulnerable and underserved populations. Works closely with the UM Medical Director to implement whole person care policies for the Health Plan. Develops and manages efforts to improve and maintain cost and utilization trends. 

Requires an MD in Psychiatry with Texas Licensure
Requires travel to El Paso, TX


This job will have the following responsibilities:

  • The Utilization Management Medical Director – Psychiatrist supports Medicare, Medicaid, CHIP and LTSS Business in Utilization Management and works with the clinical operations UM team in the development of skills related to their job. 
  • Participate in a National Queue for utilization management reviews including Part C prior authorization, inpatient concurrent review, post-acute care authorizations and concurrent reviews. To a lesser extent will also participate in the National Queue for appeals. 
  • Works collaboratively as a consultant to CM operations team to support customers in CM, not limited to, but includes participating in rounds. 
  • The Utilization Management Medical Director – Psychiatrist facilitates UM consistently and compliantly using benefit plan information, applicable CMS and state regulations, clinical guidelines, emerging codes, new trends and best practice principles. 
  • Preforms all proactive & reactive peer-to-peers prior authorization, inpatient concurrent review and post-acute prior authorization and concurrent review. Works to achieve quality outcomes for members with a focus on service and affordability.

Qualifications & Requirements:

  • Degree in Medicine from an accredited school and is licensed to practice medicine (Doctor of Medicine - Psychiatry). 
  • Texas Licensure Current active unrestricted medical license. 
  • Minimum of five years of clinical experience is required. 
  • Minimum of five years of experience in medical management, utilization review and case management in a managed care setting. 
  • Previous experience managing nurses or employees preferred. 
  • Knowledge of managed care products and strategies. Ability to work within changing business environment and balance patient advocacy with business needs.
  • Experience with managing multiple projects in a fast-paced matrix environment.

Contact: [Click Here to Email Your Resumé]

This job and many more are available through The Judge Group. Find us on the web at www.judge.com
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