Associate Medical Director, Behavioral Health

Dane Street; Northern (KY); Hybrid; USD 165,000 - 289,000; Part time

Job summary

Dane Street is seeking a Behavioral Health Associate Medical Director on a part-time contract to provide clinical leadership and SME support for the Group Health utilization review program. This role includes oversight of behavioral health physician reviewers, quality assurance, reviewer training, and client-facing activities.

The anticipated commitment is approximately five hours per month, with additional participation as mutually agreed based on business needs.

Qualifications

• MD or DO with board certification in Psychiatry.
• Active, unrestricted medical license.
• Prior utilization review experience, preferably within a health plan, IRO, or similar environment.
• Demonstrated experience with ASAM Criteria and behavioral health medical necessity review.
• Knowledge of LOCUS/CALOCUS, MCG, and InterQual.

Responsibilities

• Provide clinical oversight and SME for behavioral health utilization review activities.
• Audit initial cases and provide feedback, coaching, or retraining as needed.
• Perform ongoing and targeted audits of behavioral health panelists based on quality trends and client grievances.
• Review potential quality misses and provide timely clinical feedback and remediation to physician reviewers.
• Support QA and operational staff with live case escalations involving behavioral health determinations and evidence-based support.
• Monitor remediation effectiveness and provide follow-up guidance when quality concerns persist.
• Assist with behavioral health reviewer training and maintenance of training expectations.
• Participate in quality management and quality improvement activities related to behavioral health review services.
• Respond to client escalations or grievances and assist with root-cause remediation plans.
• Participate in client-facing calls and audits as SME; discuss clinical quality and corrective actions.
• Collaborate with Group Health leadership and medical director teams to ensure high-quality oversight.

Skills

Clinical leadership

Quality management

Audits

Feedback & coaching

Client communications

Education

MD or DO with board certification in Psychiatry

Child and Adolescent Psychiatry experience or certification

Job description

Overview

We are seeking a Behavioral Health Associate Medical Director to provide part-time clinical leadership and subject matter expertise in support of the Group Health utilization review program. This contract role provides clinical oversight of behavioral health physician reviewers, supports quality management and reviewer development, and serves as a physician resource for operational teams and clients. The anticipated commitment is approximately five hours per month, with additional participation as mutually agreed based on business or client needs.

Key Responsibilities

• Provide clinical oversight and subject matter expertise for behavioral health utilization review activities.


• Audit initial cases completed by newly onboarded behavioral health physician reviewers and provide feedback, coaching, or retraining when needed.


• Perform ongoing and targeted audits of behavioral health panelists based on quality trends, client grievances, overturn patterns, escalations, or other identified performance concerns.


• Review potential quality misses or inappropriate determinations and provide timely clinical feedback and remediation to physician reviewers.


• Support QA and operational staff with live case escalations involving behavioral health determinations, rationale quality, evidence-based support, peer-to-peer requirements, or reviewer performance.


• Monitor remediation effectiveness and provide follow-up guidance when quality concerns persist.


• Assist with behavioral health reviewer training and maintenance of reviewer training expectations and documentation.


• Participate in quality management and quality improvement activities related to behavioral health review services.


• Respond to client escalations or grievances involving behavioral health physician determinations and assist with root-cause review and remediation plans.

• Participate in client-facing calls, audits, and touch-base meetings as the behavioral health physician subject matter expert, including discussion of clinical quality, reviewer performance, and corrective actions.


• Participate in prospective client discussions as needed to provide physician perspective regarding behavioral health capabilities, panel oversight, and quality monitoring.


• Collaborate with Group Health leadership, Medical Director leadership, QA, operations, and physician network teams to support consistent, high-quality behavioral health utilization review.

• MD or DO with board certification in Psychiatry; Child and Adolescent Psychiatry experience or certification preferred.


• Active, unrestricted medical license.


• Prior utilization review experience, preferably within a health plan, independent review organization (IRO), managed care, or similar environment.


• Demonstrated experience with ASAM Criteria and behavioral health medical necessity and level-of-care review.


• Working knowledge of behavioral health utilization management criteria and guidelines, including LOCUS/CALOCUS, MCG, and InterQual.


• Strong clinical judgment and ability to evaluate the quality, consistency, and defensibility of physician determinations and rationales.


• Strong written and verbal communication skills, including the ability to provide effective physician feedback and participate in client-facing discussions.


• Ability to work independently and respond promptly to time-sensitive clinical or quality escalations.