Behavioral Health Medical Director, Utilization Management

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); On-site; USD 214,000 - 298,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks an MD or DO with an unrestricted license to lead utilization management for Behavioral Health. The role provides medical leadership, analyzes data, and guides BH clinicians on pre-authorization, case management, and medical necessity decisions.

Five years of clinical experience and three+ years in medical management within managed care are required. The position involves participating in relevant committees and contributing to provider

Qualifications

• Board-certified MD or DO with unrestricted license.
• Minimum five years of clinical experience and three+ years in medical management within managed care.
• Residency in Psychiatry; Child and Adolescent Psychiatry Fellowship (Addendum).

Responsibilities

• Provide medical leadership for behavioral health utilization management.
• Guide BH clinicians on pre-authorization, concurrent and retrospective reviews.
• Guide on medical necessity and medical appropriateness decisions.
• Participate in committee activity and provider credentialing processes as needed.
• Analyze data to identify trends and issues relevant to utilization management.

Skills

Clinical leadership

Independent judgement

Medical policy interpretation

Communication skills

Data analysis

Education

MD or DO board certified

Unrestricted medical license

Residency in Psychiatry

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks an MD or DO with an unrestricted license to lead utilization management for Behavioral Health. The role provides medical leadership, analyzes data, and guides BH clinicians on pre-authorization, case management, and medical necessity decisions.

Five years of clinical experience and three+ years in medical management within managed care are required. The position involves participating in relevant committees and contributing to provider