Behavioral Health Medical Director - Utilization Management

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 214,000 - 298,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a physician leader to oversee day-to-day utilization management in Behavioral Health, guiding reviewers on pre-authorization, concurrent and retrospective decisions. You will analyze data, participate in committees and support network development.

The role requires MD or DO with a current unrestricted license, five years of clinical experience, and at least three years in medical management in managed care.

Qualifications

• Requires MD/DO with unrestricted license in primary care specialties.
• Board certification and ongoing active licensure required.
• Minimum five years of clinical experience and three years in medical management in managed care.
• Residency in Psychiatry and subspecialty training as applicable.

Responsibilities

• Provide medical leadership for utilization management in Behavioral Health.
• Advise BH reviewers on pre-authorization, concurrent and retrospective reviews.
• Guide case management decisions and medical necessity determinations.
• Participate in development and management of complex cases and communicate plans.
• Interpret medical policy and contribute to policy and technology assessments.
• Collaborate on credentialing, profiling and network development initiatives.

Skills

Broad clinical skills

Independent medical judgement

Medical policy interpretation

Strong communication skills

Analytical data review

Education

MD or DO with unrestricted license

Residency in Psychiatry

Fellowship in Child and Adolescent Psychiatry

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a physician leader to oversee day-to-day utilization management in Behavioral Health, guiding reviewers on pre-authorization, concurrent and retrospective decisions. You will analyze data, participate in committees and support network development.

The role requires MD or DO with a current unrestricted license, five years of clinical experience, and at least three years in medical management in managed care.